动脉化疗栓塞联合CIK细胞过继免疫治疗对中晚期肝癌患者免疫功能的影响

摘要

目的 分析肝动脉化疗栓塞(TACE)联合细胞因子诱导的杀伤细胞(CIK)过继免疫治疗对中晚期肝癌患者外周血T淋巴细胞亚群及NK细胞的影响及临床意义.方法 回顾天津肿瘤医院136例中晚期原发性肝癌患者(均为TACE术后,经影像学检查显示无远处转移)资料,依据治疗方式分为两组:TACE联合CIK治疗67例为研究组,单纯TACE治疗69例为对照组.分别于治疗前、治疗后相同时间点取外周血,测定AFP、T淋巴细胞亚群及NK细胞计数变化;术后1个月采用增强CT、MRI或PET-CT评价肿瘤坏死程度.结果 研究组与对照组近期疗效及AFP下降率比较,差异无统计学意义(P ＞ 0.05).对照组治疗前后比较,CD3+、CD4+、NK细胞比率及CD4+/CD8+分别由(50.26 ± 6.37)%、(53.20 ± 9.29)%、(21.03 ± 8.58)%、1.58 ± 0.43下降至(48.95 ± 8.83)%(P ＞ 0.05)、(50.09 ± 9.99)%(P ＜ 0.01)、(19.63 ± 8.42)%(P ＞ 0.05)、1.44 ± 0.52(P ＜ 0.01),CD8+、Treg细胞比率分别由(35.70 ± 8.71)%、(6.55 ± 1.47)%上升至(38.04 ± 10.50)%(P ＜ 0.05)、(6.76 ± 1.67)%(P ＞ 0.05).研究组治疗前后比较,CD3+、CD4+、NK细胞比率及CD4+/CD8+分别由(50.51 ± 12.37)%、(52.48 ± 15.55)%、(20.67 ± 10.92)%、1.76 ± 0.90上升至(53.62 ± 11.37)%(P ＜ 0.01)、(55.62±14.63)%(P ＜ 0.05)、(23.23 ± 10.37)%(P ＜ 0.01)、1.94 ± 0.84(P ＜ 0.01),CD8+、Treg细胞比率分别由(35.61±12.90)%、(6.57 ± 4.88)%下降至(32.68 ± 10.56)%(P ＜ 0.05)、(4.77 ± 1.99)%(P ＜ 0.01).结论 TACE术后联合CIK细胞过继性免疫治疗可以改善患者免疫状态,提高机体的抗肿瘤免疫效应,有可能降低中晚期HCC患者TACE术后的复发和转移机会.%Objective To investigate the influence of TACE and autologous cytokine-induced killer (CIK) cells on the peripheral T lymphocyte subsets and native killer cell in patients with advanced primary hepatocellular carcinoma (HCC). Methods A total of 136 patients with unresectable HCC were divided into study group (n = 67, patients were treated with CIK cell therapy after TACE), and control group (n = 69,patients were treated with TACE only). The serum levels of AFP, T lymphocyte subsets and native killer (NK) cell in peripheral blood of HCC patients were determined before and after the treatment. Tumor condition was observed by CT, MRI or PET-CT one month after the treatment. Results No significant difference in serum AFP level decrease and therapeutic effectiveness existed between two groups (P ＞ 0.05).In the control group , the percentages of CD3+,CD4+, NK cells and the proportion of CD4+/CD8+ decreased from (50.26 ± 6.37)％, (53.20 ± 9.29)％, (21.03 ± 8.58)％, 1.58 ± 0.43 to (48.95 ± 8.83)％(P ＞ 0.05) ,(50.09 ± 9.99)％ (P ＜ 0.01) . (19.63 ± 8.42)％ (P＞ 0.05) , 1.44 ± 0.52 (P ＜ 0.01) respectively,while CD8+ and Treg cells increased from (35.70± 8.71)％, ( 6.55 ± 1.47 )％ to ( 38.04 ± 10.50)％respectively. In the study group, the percentages of CD3+,CD4+,NK cells and the proportion of CD4+/CD8+increased from (50.51 ± 12.37)％. (52.48 ± 15.55)％, (20.67 ± 10.92)％. 1.76 ± 0.90 respectively to (53.62 ± 11.37)％(P ＜ 0.01) . (55.62±14.63)％(P ＜ 0.05 ) , (23.23 ± 10.37)％ (P ＜0.01) , 1.94 ±0.84 (P＜ 0.01) respectively, while CD8+ and Treg cells decreased from (35.61 ± 12.90)％, (6.57 ± 4.88)％ to (32.68 ± 10.56)％ (P ＜ 0.05) , (4.77 ± 1.99)％ (P ＜ 0.01) respectively. Conclusion Autologous CIK cells transfusion after TACE can efficiently improve the immunological status in HCC patients, moreover, it may provide a potent means to reduce the recurrence rate of HCC. (J Intervent Radiol, 2011. 20 : 116-119)