CAJ | 학술논문

目的：探讨Foxp3＋调节性T细胞（Treg）与超加利福尼亚大学洛杉矶分校（UCSF）标准肝细胞癌（肝癌）肝移植患者术后肿瘤复发的关系。方法回顾性分析2010年1月至2013年12月在解放军第309医院全军器官移植研究所接受肝移植的24例肝癌患者的临床资料。在随访期内肿瘤复发4例（肿瘤复发组），余20例无复发（肿瘤未复发组）；以同期健康人的血液标本为对照组。比较肿瘤复发组和肿瘤未复发组术前、术后不同时点甲胎蛋白（AFP）水平；比较肿瘤复发组和肿瘤未复发组术前、术后不同时点及对照组的 Foxp3＋Treg （Foxp3＋Treg％）水平；对术前与术后 Foxp3＋Treg 表达与 AFP、CD3＋和 CD8＋T 水平的关系进行相关分析。结果与术前及正常水平相比，肿瘤未复发组患者术后 Foxp3＋Treg 表达经历先降低后逐渐升高最终稳定于较低水平。与肿瘤未复发组患者比较，肿瘤复发组患者的 AFP 和 Foxp3＋Treg 显著升高，明显高于术前及正常水平（均为 P ＜0.01），而且在肿瘤复发组患者中 Foxp3＋Treg 早期异常性升高先于 AFP。相关性分析提示，Foxp3＋Treg 与AFP 变化一致，呈正相关（P ＜0.01）；而与效应性 T 细胞（CD3＋T 细胞、CD8＋ T 细胞）表达变化相反，呈负相关（P ＜0.05～0.01）。结论Foxp3＋Treg 与肝癌肝移植术后肿瘤复发的关系密切。超UCSF 标准的肝癌肝移植患者术后 Foxp3＋Treg 越高，提示复发风险越大，联合检测 AFP 有助于及早发现肿瘤复发。
목적：탐토Foxp3＋조절성T세포（Treg）여초가리복니아대학락삼기분교（UCSF）표준간세포암（간암）간이식환자술후종류복발적관계。방법회고성분석2010년1월지2013년12월재해방군제309의원전군기관이식연구소접수간이식적24례간암환자적림상자료。재수방기내종류복발4례（종류복발조），여20례무복발（종류미복발조）；이동기건강인적혈액표본위대조조。비교종류복발조화종류미복발조술전、술후불동시점갑태단백（AFP）수평；비교종류복발조화종류미복발조술전、술후불동시점급대조조적 Foxp3＋Treg （Foxp3＋Treg％）수평；대술전여술후 Foxp3＋Treg 표체여 AFP、CD3＋화 CD8＋T 수평적관계진행상관분석。결과여술전급정상수평상비，종류미복발조환자술후 Foxp3＋Treg 표체경력선강저후축점승고최종은정우교저수평。여종류미복발조환자비교，종류복발조환자적 AFP 화 Foxp3＋Treg 현저승고，명현고우술전급정상수평（균위 P ＜0.01），이차재종류복발조환자중 Foxp3＋Treg 조기이상성승고선우 AFP。상관성분석제시，Foxp3＋Treg 여AFP 변화일치，정정상관（P ＜0.01）；이여효응성 T 세포（CD3＋T 세포、CD8＋ T 세포）표체변화상반，정부상관（P ＜0.05～0.01）。결론Foxp3＋Treg 여간암간이식술후종류복발적관계밀절。초UCSF 표준적간암간이식환자술후 Foxp3＋Treg 월고，제시복발풍험월대，연합검측 AFP 유조우급조발현종류복발。
Objective To discuss the relationship between Foxp3 +regulatory T cell (Treg)and tumor recurrence of patients after liver transplantation for primary hepatocellular carcinoma (HCC) over University of California,San Francisco (UCSF)criteria.Methods Clinical data of 24 patients with HCC undergoing liver transplantation in the Organ Transplantation Research Institute of the 309 th Hospital of People's Liberation Army from January 2010 to December 2013 were retrospectively studied.During the follow-up,4 patients recurred (tumor recurrence group)and other 20 patients did not recur (tumor non-recurrence group).The blood samples of healthy people was selected as control group at the same period.The levels of alpha-fetoprotein (AFP)were compared at different time points of the recurrence group and the non-recurrent group before and after transplantation.The levels of Foxp3 +Treg (Foxp3 +Treg%)were compared at different time points of the tumor recurrence group,the tumor non-recurrence group and the control group before and after transplantation.The relations between expression of Foxp3 +Treg and the levels of AFP,CD3 + and CD8 +T before and after transplantation were analyzed by correlation analysis.Results Compared with the level of Foxp3 +Treg before transplantation and the normal level,the expression of Foxp3 +Treg of patients in tumor non-recurrence group after transplantation firstly decreased,then gradually increased and finally stabilized at a low level.Compared with patients in tumor non-recurrence group,the levels of AFP and Foxp3 +Treg of patients in tumor recurrence group increased obviously and were significantly higher than the normal levels (both in P <0.01).Moreover,abnormal increase of Foxp3 +Treg at early stage was prior to AFP among the patients in tumor recurrence group.Correlation analysis indicated that the change of Foxp3 +Treg was consistent with the changes of AFP,which was positively correlated (P <0.01).But the change of Foxp3 +Treg was contrary to the change of effector T cells (CD3 +T cells and CD8 + T cells),which was negatively correlated (P <0.05-0.01).Conclusions Foxp3 +Treg is closely associated with tumor recurrence after liver transplantation for HCC.In the patients after liver transplantation for HCC over UCSF criteria,the higher Foxp3 +Treg is,the higher the recurrence risk is.Joint detection of AFP is beneficial to find tumor recurrence.