CAJ | 학술논문

目的观察树突状细胞(DC)疫苗联合细胞因子诱导的杀伤细胞(CIK细胞)腹腔灌注治疗恶性腹腔积液的安全性和有效性.方法回顾性分析51例传统治疗失败的恶性腹腔积液患者的治疗情况.治疗组(22例)采用血细胞分离机采集外周血单个核细胞(PBMC),经体外诱导培养成DC和CIK细胞.将DC和CIK细胞混匀后进行腹腔灌注,隔日1次,共3次;对照组(29例)仅进行姑息性穿刺排出腹腔积液及利尿处理.观察所有患者治疗前后外周血淋巴细胞亚群变化;参照WHO癌性积液疗效评价标准和常见不良反应评价标准(NCI-CTCAE v4.0)评价近期临床疗效和安全性;根据Karnofsky功能状态评分评估患者生活质量(QOL)改变.结果治疗组外周血中CD4+ CD25+调节性T细胞(Treg细胞)比例升高较对照组缓慢,差异有统计学意义(P＜0.05).治疗组有效率(RR) 40.9％(9/22),疾病控制率(DCR) 77.3％(17/22),对照组RR为10.3％(3/29),DCR为27.6％(8/29),两组差异均有统计学意义(均P＜ 0.05).治疗组QOL改善13例(59.1％),稳定5例(22.7％),降低4例(18.2％);对照组QOL改善3例(10.3％),稳定5例(17.2％),降低21例(72.4％),两组差异有统计学意义(P＜0.05).治疗组所有患者均未出现3～4级不良反应.结论 DC疫苗联合CIK细胞腹腔灌注治疗恶性腹腔积液是安全的,即使在传统治疗效果不佳或失败时也可以取得一定临床获益.
목적 관찰수돌상세포(DC)역묘연합세포인자유도적살상세포(CIK세포)복강관주치료악성복강적액적안전성화유효성.방법 회고성분석51례전통치료실패적악성복강적액환자적치료정황.치료조(22례)채용혈세포분리궤채집외주혈단개핵세포(PBMC),경체외유도배양성DC화CIK세포.장DC화CIK세포혼균후진행복강관주,격일1차,공3차;대조조(29례)부진행고식성천자배출복강적액급이뇨처리.관찰소유환자치료전후외주혈림파세포아군변화;삼조WHO암성적액료효평개표준화상견불량반응평개표준(NCI-CTCAE v4.0)평개근기림상료효화안전성;근거Karnofsky공능상태평분평고환자생활질량(QOL)개변.결과 치료조외주혈중CD4+ CD25+조절성T세포(Treg세포)비례승고교대조조완만,차이유통계학의의(P＜0.05).치료조유효솔(RR) 40.9％(9/22),질병공제솔(DCR) 77.3％(17/22),대조조RR위10.3％(3/29),DCR위27.6％(8/29),량조차이균유통계학의의(균P＜ 0.05).치료조QOL개선13례(59.1％),은정5례(22.7％),강저4례(18.2％);대조조QOL개선3례(10.3％),은정5례(17.2％),강저21례(72.4％),량조차이유통계학의의(P＜0.05).치료조소유환자균미출현3～4급불량반응.결론 DC역묘연합CIK세포복강관주치료악성복강적액시안전적,즉사재전통치료효과불가혹실패시야가이취득일정림상획익.
Objective To evaluate the safety and efficacy of dendritic cell (DC) vaccines combined with cytokine-induced killer (CIK) cells intraperitoneal injection on patients with malignant peritoneal effusion.Methods Clinical data of 51 patients with malignant peritoneal effusion after the failure of conventional treatment methods were analyzed retrospectively.Peripheral blood mononuclear cells (PBMC) were collected by blood cell separator from 22 patients of treatment group.PBMC were cultured in vitro to produce DC vaccines and CIK cells.DC and CIK cells were injected peritoneally with the cell mixture,q.o.d,3 times.The patients of control group were dealt with peritoneal puncture and diuretic therapy.The changes of peripheral blood lymphocyte subsets between pre-and post-treatment were evaluated.Short-term clinical efficacy was evaluated according to WHO cancerous effusion criteria and safety according to NCI-CTCAE v4.0 version criteria respectively.The changes of patients' quality of life (QOL) were evaluated according to Karnofsky score.Results The percentage CD4+ CD25+ Treg cells in treatment group slowly declined after treatment compared with control group (P ＜ 0.05).The clinical response rate (RR) was 40.9 ％ (9/22) and disease control rate (DCR) was 77.3 ％ (17/22) in treatment group.The RR was 10.3 ％ (3/29) and DCR was 27.6 ％ (8/29) in control group.There was significant differences in RR and DCR between treatment group and control group (P ＜ 0.05).There were thirteen cases with QOL improvement,five cases with QOL stability,four cases with QOL decrease after treatment in treatment group.There were three cases with QOL improvement,five cases with QOL stability,twenty-one cases with QOL decrease after treatment in control group.There was significant difference in QOL between treatment group and control group (P ＜ 0.05).No grade 3-4 adverse event happened in all cases.Conclusions DC vaccines combined with CIK cells intraperitoneal injection on patients with malignant peritoneal effusion is safe and feasible.This therapy modality can achieve a certain clinical benefits even in patients resistant to conventional treatment.