高危型HPV感染者外周血T细胞亚群和NK细胞检测及临床价值

摘要

目的 探讨高危HPV感染宫颈不同病变患者外周血T淋巴细胞亚群和NK细胞数量变化及其临床价值.方法 收集2007年9月至2014年9月在陕西省肿瘤医院治疗的CIN Ⅰ 59例、CINⅡ107例、CINⅢ138例、宫颈癌Ⅰ期179例、宫颈癌Ⅱa期261例、宫颈癌Ⅱb期232例、宫颈癌Ⅲa期173例、宫颈癌Ⅲb期131例、宫颈癌Ⅳ期63例及同期146例正常对照组女性.采用流式细胞仪测定各组患者外周血CD3+、CD4+、CD8+、CD4 +/CD8+和CD16+ CD56+淋巴细胞数量.结果 高危型HPV感染宫颈不同病变患者CD4+、CD16+ CD56+细胞数量及CD4 +/CD8+比值均低于对照组,且随病变严重程度递增而逐步降低(P＜0.01);而CD8+细胞数量则高于对照组,且随病变严重程度递增而逐步增高(P＜0.01).所有高危HPV感染宫颈癌患者细胞免疫功能均明显低于对照组患者(P＜0.05),且随病变严重程度的递增而明显降低.有淋巴结转移的宫颈癌患者细胞免疫功能明显低于没有淋巴结转移的宫颈癌患者(P＜0.05);宫颈癌不同组织分化淋巴细胞亚群及NK细胞检测结果各组之间均无统计学意义(P＞0.05).但低分化患者的CD4+、CD8+细胞数量及CD4+/CD8+比值则明显低于高分化患者.CD4+、CD16+ CD56+细胞数量减少及CD4+/CD8+细胞比值下降与宫颈癌临床分期呈明显负相关(P＜0.01);CD8+细胞数量增加则与宫颈癌临床分期呈明显正相关(P＜0.001).结论 高危HPV感染不同宫颈病变患者的细胞免疫功能均不同程度降低,以宫颈癌晚期患者细胞免疫功能降低最为显著.检测T淋巴细胞亚群及NK细胞可用于宫颈癌患者的免疫监测,并可给预后评估和临床治疗提供参考.%Objective To investigate peripheral blood T lymphocyte subsets and NK cells in patients with high-risk HPV infection and different cervical lesions and its clinical value.Methods 126 cases of patients with 31 cases of patients with stage Ⅰ,56 cases of patients with stage Ⅱ,73 cases of patients with stage Ⅲ of cervical intraepithelial neoplasia (CIN),95 cases of patients with clinical stage,138 cases of patients with clinical stage Ⅱ a,124 cases of patients with clinical stage Ⅱ b,92 cases of patients with clinical stage Ⅲ a,69 cases of patients with clinical stage Ⅲ b,33 cases of patients with clinical stage Ⅳ of cervical carcinoma and 78 cases of healthy women as healthy control from September 2007 to September 2014 in Shaanxi Provincial Tumor Hospital were admitted and their peripheral blood CD3+,CD4 +,CD8 +,CD4 +/CD8 + lymphocyte subsets and CD16 + CD56+ cells were detected by flow cytometry.Results Different patients with high-risk HPV infection in cervical lesions,CD4 +,CD16 + CD56 + cells and the numbers of CD4 +/CD8 + ratio were lower than those in the healthy control group,and with the severity of lesions increment to gradually reduce (P ＜ 0.01),while CD8 + cell numbers were higher than those in the healthy control group,and with increasing severity lesions gradually increased (P ＜ 0.01).The cellular immune function of all patients with cervical carcinoma were significantly lower than those in healthy control group,and with the severity of lesions increment to gradually reduce.The cellular immune function of patients of cervical carcinoma with lymph node metastasis were significantly lower than that in patients without lymph node metastasis (P ＜ 0.01),and in patients with well differentiated,poorly differentiated and moderately differentiated of cervical carcinoma group were no difference between them (P ＞ 0.05).But CD4 +,CD8 + cells and CD4 +/CD8 + ratio of patients with low differentiation are significantly lower than patients with well-differentiated.The number of cells of CD4 +,CD16 + CD56 + reducing and CD4 +/CD8 + ratio decreased were negative correlated to clinical stages of cervical carcinoma,namely were decreased with the increasing of clinical stages(P ＜ 0.01).The number of CD8 + cell was positive correlated with clinical stages of cervical carcinoma.(P ＜ 0.001).Conclusions The cellular immune function of the patients with high-risk HPV infection and different cervical lesions are lower and especially even worse in patients with cervical carcinoma and with advanced clinical stages.Detecting T lymphocyte subsets and NK immune cells can be used to monitor cellular immune function of patients with cervical carcinoma and to estimate prognosis and provide reference for clinical treatment.