CAJ | 학술논문

背景与目的:调节性T细胞(regulatory T cells,Treg cells)可以抑制免疫系统的抗肿瘤反应,在恶性肿瘤的发生过程中,外周血中Treg细胞的数量随着疾病的严重程度增加而增加.本研究旨在探讨Treg细胞在宫颈癌发生、发展中可能产生的作用.方法:采用流式细胞术检测61例宫颈鳞癌(squamous cell carcinoma,SCC),8例宫颈腺癌(adenocarcinoma,ADC),41例高级别宫颈上皮内瘤变(high-grade cervical intraepithelial neoplasias,HG-CIN)患者和17例健康女性体检者外周血中Treg细胞占CD4+T细胞的比率.结果:ADC、SCC、HG-CIN患者和健康对照者中Treg细胞占外周血CD4+T细胞的比率(x±s)分别为:(10.73±2.88)%、(10.31±2.45)%、(9.20±2.28)%和(7.88±1.18)%,各组间差异有统计学意义(P=0.001).在宫颈鳞状上皮病变中,外周血中Treg细胞的水平随着病变的恶性程度增加逐渐升高(SCC>HG-CIN>NLM,P<0.001).在69例浸润性宫颈癌中,根据2009 FIGO分期,I期为37例,Ⅱ期为32例.17例(24.6%)患者术后被发现有盆腔淋巴结转移.恶性程度较高的肿瘤中Treg细胞的数量高于恶性程度较低的肿瘤,包括FIGOⅡ期高于Ⅰ期[(10.67±2.67)% vs (10.00±2.24)%]、肿瘤直径>4 cm高于肿瘤直径≤4 cm[(10.68±2.31)% vs (10.04±2.63)%]、有盆腔淋巴结转移的肿瘤高于无盆腔淋巴结转移的肿瘤[(11.06±2.56)% vs (10.13±2.44)%].但统计检验未发现Treg细胞的数量和肿瘤的临床分期、盆腔淋巴结转移、脉管浸润、肿瘤大小及纤维肌壁浸润程度有相关性(P>0.05).结论:宫颈上皮内瘤变和宫颈癌患者外周血中Treg细胞比例增高,并且与宫颈上皮恶性转化的程度呈正相关,但其在浸润性宫颈癌形成后的进展过程中的作用有待进一步探讨.
배경여목적:조절성T세포(regulatory T cells,Treg cells)가이억제면역계통적항종류반응,재악성종류적발생과정중,외주혈중Treg세포적수량수착질병적엄중정도증가이증가.본연구지재탐토Treg세포재궁경암발생、발전중가능산생적작용.방법:채용류식세포술검측61례궁경린암(squamous cell carcinoma,SCC),8례궁경선암(adenocarcinoma,ADC),41례고급별궁경상피내류변(high-grade cervical intraepithelial neoplasias,HG-CIN)환자화17례건강녀성체검자외주혈중Treg세포점CD4+T세포적비솔.결과:ADC、SCC、HG-CIN환자화건강대조자중Treg세포점외주혈CD4+T세포적비솔(x±s)분별위:(10.73±2.88)%、(10.31±2.45)%、(9.20±2.28)%화(7.88±1.18)%,각조간차이유통계학의의(P=0.001).재궁경린상상피병변중,외주혈중Treg세포적수평수착병변적악성정도증가축점승고(SCC>HG-CIN>NLM,P<0.001).재69례침윤성궁경암중,근거2009 FIGO분기,I기위37례,Ⅱ기위32례.17례(24.6%)환자술후피발현유분강림파결전이.악성정도교고적종류중Treg세포적수량고우악성정도교저적종류,포괄FIGOⅡ기고우Ⅰ기[(10.67±2.67)% vs (10.00±2.24)%]、종류직경>4 cm고우종류직경≤4 cm[(10.68±2.31)% vs (10.04±2.63)%]、유분강림파결전이적종류고우무분강림파결전이적종류[(11.06±2.56)% vs (10.13±2.44)%].단통계검험미발현Treg세포적수량화종류적림상분기、분강림파결전이、맥관침윤、종류대소급섬유기벽침윤정도유상관성(P>0.05).결론:궁경상피내류변화궁경암환자외주혈중Treg세포비례증고,병차여궁경상피악성전화적정도정정상관,단기재침윤성궁경암형성후적진전과정중적작용유대진일보탐토.
@@@@Background and purpose: High-risk types of human papillomavirus are the causative agents for cervical carcinogenesis. Regulatory T cells (Treg cells) characterized by CD4+CD25highCD127low have been shown to be involved in virus-induced persistent infection. Treg cells are found to be increased in peripheral blood and tumor microenvironment of patients with solid tumors. The aim of this study was to compare the frequencies of Treg cells in the peripheral blood among cervical cancers and its precursors. Methods: Peripheral blood was collected from 61 patients with cervical squamous cell carcinomas (SCC), 8 patients with cervical adenocarcinomas (ADC), 41 patients with high-grade cervical intraepithelial neoplasia (CIN) and 17 normal controls (NLM). Flow cytometry was employed to measure the frequency of CD4+CD25highCD127low Treg cells among CD4+ T cells in peripheral blood. The means of frequency of Treg cells were compared among groups using one-way ANOVA and t-test. Results: The frequency of Treg cells among CD4+ T cells in the peripheral blood (x±s) was (10.73±2.88)%, (10.31±2.45)%, (9.20±2.28)% and (7.88±1.18)% in ADC cases, SCC cases, CIN cases and normal controls, respectively (P=0.001). Among squamous lesions, the amount of Treg cells was elevated and correlated with the severity of the disease (SCC>CIN>NLM, P<0.001). The frequencies of Treg cells were higher in ADC cases compared to SCC cases, however, there was no statistic significance (P=0.657). Among the 69 invasive carcinomas, the mean age was 47.8 (29-70) years old. Thirty-two and 37 patients were diagnosed as stage Ⅰand stage Ⅱ, respectively (FIGO staging 2009). Seventeen (24.6%) patients had pelvic lymph node metastasis. There was a trend that advanced cases had more Treg cells in their peripheral blood, however, no statistical difference was found between the amount of Treg cells and any clinico-pathologic parameters, such as FIGO stage [Ⅱ vs Ⅰ: (10.67±2.67)% vs (10.00±2.24)%, P=0.266], tumor size [>4 cm vs ≤4 cm:(10.68±2.31)% vs (10.04±2.63)%, P=0.284] and lymph node metastasis[positive vs negative: (11.06±2.56)% vs (10.13±2.44)%, P=0.181]. Conclusion: The frequencies of Treg cells in peripheral blood were increased in patients with cervical intraepithelial neoplasia and cervical cancers, which indicated that Treg cells might play a critical role in malignant transformation of cervical intraepithelium. However, their significance in the progression of invasive carcinomas warrants further study.