CAJ | 학술논문

目的观察中低位直肠癌患者新辅助化疗后对肿瘤细胞增殖能力及外周血T淋巴细胞亚群凋亡的影响.方法癌灶黏膜送检45例Ⅲ、Ⅳ期中低位直肠癌观察术前接受新辅助化疗前后肿瘤细胞增殖能力变化,并以流式细胞术检测患者化疗前1d、化疗结束后1、3、5d外周血淋巴细胞CD3、CD4、CD8表达,比较淋巴细胞的凋亡及坏死.结果实验组直肠癌组织的增殖细胞核抗原(PCNA)阳性表达率低于对照组,表达下降以化疗结束后24 h最低,7～10d可恢复到化疗前水平.化疗开始2d后,CD3、CD4、CD8细胞数量与化疗前1d比较下降明显[(32.19±2.89)％比(58.17±6.95)％、(22.32±2.72)％比(40.25±9.22)％、(15.76±5.41)％比(23.72±3.62)％,P＜0.05].化疗结束3d后各指标全面回升,CD3、CD4细胞数量与化疗1d前比较差异无统计学意义(P＞0.05).化疗后5d,外周血CD3+、CD4+均升高,与化疗前比较,CD4 +/CD8+明显升高[(4.55±1.31)％比(1.28±0.58)％],而CD8+T淋巴细胞则明显下降[(11.18±7.21)％比(23.72±3.62)％],差异有统计学意义(P＜0.05).结论新辅助放化疗能明显抑制直肠癌肿瘤细胞的增殖,化疗结束至手术间歇期以7 ～10d为宜.有效的新辅助化疗可通过调节肿瘤环境T细胞水平促使患者免疫功能的好转.
목적 관찰중저위직장암환자신보조화료후대종류세포증식능력급외주혈T림파세포아군조망적영향.방법 암조점막송검45례Ⅲ、Ⅳ기중저위직장암관찰술전접수신보조화료전후종류세포증식능력변화,병이류식세포술검측환자화료전1d、화료결속후1、3、5d외주혈림파세포CD3、CD4、CD8표체,비교림파세포적조망급배사.결과 실험조직장암조직적증식세포핵항원(PCNA)양성표체솔저우대조조,표체하강이화료결속후24 h최저,7～10d가회복도화료전수평.화료개시2d후,CD3、CD4、CD8세포수량여화료전1d비교하강명현[(32.19±2.89)％비(58.17±6.95)％、(22.32±2.72)％비(40.25±9.22)％、(15.76±5.41)％비(23.72±3.62)％,P＜0.05].화료결속3d후각지표전면회승,CD3、CD4세포수량여화료1d전비교차이무통계학의의(P＞0.05).화료후5d,외주혈CD3+、CD4+균승고,여화료전비교,CD4 +/CD8+명현승고[(4.55±1.31)％비(1.28±0.58)％],이CD8+T림파세포칙명현하강[(11.18±7.21)％비(23.72±3.62)％],차이유통계학의의(P＜0.05).결론 신보조방화료능명현억제직장암종류세포적증식,화료결속지수술간헐기이7 ～10d위의.유효적신보조화료가통과조절종류배경T세포수평촉사환자면역공능적호전.
Objective To investigate the tumor cell proliferation and peripheral blood T lymphocyte subsets amount in Ⅲ,Ⅳ interim low rectal carcinoma patients receiving neoadjuvant chemotherapy.Methods The cancer foci mucosae of 45 cases of Ⅲ,Ⅳ interim low rectal carcinoma were inspected to compare the change of tumor cell proliferation before and after chemotherapy.The blood samples from these patients were collected before and after neoadjuvant chemotherapy.Flow cytometry was applied to detect the CD3 +,CD4 +,CD8 + expression,lymphocyte apoptosis and necrosis in these samples.Results Proliferating cell nuclear antigen (PCNA) expression in rectal cancer tissue was lower in experimental group than in control group.The lowest expression occurred at 24 h after chemotherapy,and the expression at 7th-10th d returned to the level before chemotherapy.At 2nd day after chemotherapy,the number of CD3 +,CD4 +,and CD8+ cells was significantly reduced as compared that at 1st day before chemotherapy [(32.19 ± 2.89)％ vs.(58.17±6.95)％,(22.32±2.72)％ vs.(40.25±9.22)％,and (15.76±5.41)％ vs.(23.72 ± 3.62) ％,P ＜ 0.05].These indexes were increased at 3 rd day after chemotherapy.The number of CD3 + and CD4 + cells showed no significant difference from that at 1 st day before chemotherapy (P ＞ 0.05).At 5th day after chemotherapy,the number of CD3 + and CD4 + cells in peripheral blood was increased,ratio of CD4 +/CD8 + was significantly increased [(4.55 ± 1.31) ％ vs.(1.28 ± 0.58) ％],and number of CD8 + T lymphocytes was significantly decreased [(11.18 ± 7.21) ％ vs.(23.72 ± 3.62) ％] as compared with those before chemotherapy (P ＜ 0.05 for all).Conclusion Neoadjuvant chemotherapy can significantly inhibit the proliferation of tumor cells in rectal carcinoma.The appropriate interim period during the end of chemotherapy to surgery is 7-10 days.Effective neoadjuvant chemotherapy may improve immune function in interim low rectal carcinoma patients by regulating the T cell levels in tumor microenvironment.