肝动脉化疗栓塞术对原发性肝癌合并HIV/AIDS患者T淋巴细胞亚群的影响

摘要

Objective To investigate the changes of T lymphocyte subsets in patients with primary hepatocellular carcinoma (PHC) complicated with acquired immune deficiency syndrome (AIDS) before and after transcatheter arterial chemoembolization (TACE) .Methods The retrospective case control study was adopted .17 patients of PHC complicated with AIDS treated in Public Health Clinical Center of Chengdu from July of 2014 to June of 2016 were selected into the experiment group ,while the other 32 PHC cases without HIV infection over the corresponding period were selected into the control group .The flow cytometry (FCM ) was adopted to measure the Counts of CD3 ,CD4 ,CD8 T lymphocyte and the ratio of CD4 to CD8 in peripheral blood 1 day before TACE in both groups and 1 and 4 weeks after TACE in the experiment group respectively .The differences of T lymphocyte subsets in peripheral blood before TACE between the two groups were compared ,and the dynamic changes of T lymphocyte subsets in peripheral blood of the experiment group 1 and 4 weeks after TACE were compared .Results The counts of CD3 and CD4 and the ratio of CD4 to CD8 in peripheral blood in the experiment group were significantly lower than those in the control group before TACE (P< 0.05) ,while the count of CD8 in the experiment group was significantly higher than that in the control group (P<0.05) .The counts of CD3 and CD4 and the ratio of CD4 to CD8 in peripheral blood were significantly reduced (P<0.05) and the count of CD8 was significantly increased (t=8.433) (P<0.05) 1 week after TACE than 1 day before TACE .The counts of CD3 and CD4 and the ratio of CD4 to CD8 in peripheral blood were significantly increased (P<0.05) and the count of CD8 was significantly reduced (P<0.05) 4 weeks after TACE than 1 week after TACE .Conclusion TACE is a safe and effective treatment for the patients with PHC complicated with HIV /AIDS .The cellular immune function of the patients with PHC complicated with HIV/AIDS is significantly lower than that of the PHC patients without HIV infection and TACE could significantly improve the cellular immunity of the patients with PHC complicated with HIV/AIDS by inhibiting it at first .%目的 探讨原发性肝癌(primary hepatic carcinoma,PHC)合并人类免疫缺陷病毒(human immunodeficiency virus,HIV)/获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)患者肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)前后T细胞亚群的变化.方法 采用回顾性病例对照研究,选取2014年7月至2016年6月在成都市公共卫生临床医疗中心就诊的17例PHC合并HIV/AIDS患者为试验组,同期HIV阴性的PHC患者32例为对照组.采用流式细胞术(FCM)检测两组患者术前1 d及试验组患者术后1、4周外周血CD3、CD4、CD8 T细胞及CD4/CD8的比值,比较两组患者术前1 d及试验组术后1、4周外周血T细胞亚群各指标的动态变化.结果 试验组术前外周血T细胞亚群CD3、CD4、CD4/CD8比值明显低于对照组,而CD8明显高于对照组(P<0.05);试验组治疗1周后,外周血T细胞亚群CD3、CD4、CD4/CD8比值明显较治疗前下降,CD8明显增高(P<0.05),而4周后外周血T细胞亚群CD3、CD4及CD4/CD8比值较治疗1周后明显增高,CD8明显下降(P<0.05).结论 TACE对PHC合并HIV/AIDS患者是安全、有效的治疗方法.PHC合并HIV/AIDS患者细胞免疫较HIV阴性的PHC患者明显低下,TACE治疗PHC合并HIV/AIDS患者,细胞免疫状态呈现先抑制后恢复的趋势.