肾癌术后免疫治疗T细胞亚群检测及疗效观察

摘要

To detect T cell - subsets and observe the effect of IL - 2 immunotherapy in postoperative renal cell carcinoma. Methods:All 98 cases of postoperative renal cell carcinoma were randomly divided into two groups:Experimental group(58 cases)were treated with IL - 2,subcutaneous injection of small dose(600 - 1000k IU),once every other day for 3 months,the next year programme as previous;Control group(40 cases)were only given radical nephrectomy,without immune therapy. Peripheral blood CD3 + ,CD4 + ,CD8 + ,CD4 + / CD8 + were dectat-ed in two groups with different times(before treatment,2months after treatment,6months after treatment). Survival rates,quality of life(KPS)score and adverse reaction were observed. Results:There were no significant differences in CD3 + ,CD4 + ,CD4 + / CD8 + between two groups before treatment(P ﹥ 0. 05). Experimental group were higher than those of control group 2months and 6months after treatment(P ﹤ 0. 05). Experimental group survival rate was 100%after 1 year(58 / 58). Control group was 97. 5%(39 / 40),there was no significant difference(P ﹥ 0. 05). Experimen-tal group survival rate was 84. 5% after 3 years(49 / 58),which was significantly higher than that of control group 67. 5%(27 / 40)(P ﹤ 0. 05). Quality life score increased by an average of 19. 6 in experimental group 1 year postop-eration and 11. 5 3 years later,which were significantly higher than control group(P ﹤ 0. 05). A total of 12 cases of adverse reactions in experimental group,which were transient;there was no related adverse reaction in control group. Conclusion:Application of IL - 2 immune postoperation therapy can improve the immunity level,exert antitumor effects,increase survival rate and improve the quality of life with less side effects.%目的：检测肾癌术后患者 IL -2免疫治疗前后对外周血 T 淋巴细胞亚群的水平影响，进一步观察其对肾癌术后患者的疗效。方法：肾癌术后患者98例随机分为两组：实验组58例采用 IL -2治疗，皮下注射小剂量（60-100万 IU/次），隔日1次，共3月，以后每年方案同前1年。对照组40例只给予肾癌根治术，不予免疫治疗。应用流式细胞技术检测两组患者不同时间段（治疗前，治疗后2月、6月）外周血 CD3+、CD4+、CD8+、CD4+/ CD8+，并进行对比研究。观察两组治疗后1年、3年生存率、生活质量（KPS）评分以及不良反应。结果：实验组与对照组 CD3+、CD4+、CD4+/ CD8+在治疗前无明显差异（P ﹥0.05），治疗后2月、6月较对照组明显升高（P ﹤0.05）。术后1年实验组生存率100%（58/58），对照组97.5%（39/40），两者无明显差异（P ﹥0.05）；术后3年实验组生存率84.5%（49/58），明显高于对照组（67.5%，27/40）（P ﹤0.05）。实验组术后1年生活质量评分平均升高19.6分，3年生活质量评分平均升高11.5分，均明显高于对照组3.7分、1.4分（P ﹤0.05）。实验组不良反应共12例，均为一过性，未影响免疫治疗。对照组无相关不良反应。结论：肾癌根治术后应用 IL -2进行免疫治疗，可以提高患者免疫水平，发挥抗肿瘤作用，提高生存率，改善生活质量，不良反应较轻。