【摘要】 目的分析肾动脉栓塞(transcatheter renal arterial embolization,TRAE)联合细胞因子诱导的杀伤细胞(cy-tokine-induced killer cell,CIK cell)过继免疫治疗对中晚期肾癌患者外周血CD4+CD25+调节性T细胞(regulatory Tcell,Treg)细胞比例、细胞免疫功能的影响及临床意义。资料与方法 65例中晚期肾癌患者(均为TRAE术后,经影像学检查显示无远处转移),以入院先后顺序随机分为两组:TRAE联合CIK治疗30例为研究组,单纯TRAE治疗35例为对照组,研究组患者在TRAE术后1周静脉补充CIK细胞治疗。分别于治疗前1周、治疗后3个月取外周血,流式细胞仪检测T淋巴细胞亚群及NK细胞比例变化;术后采用增强CT、MRI或PET-CT评价肿瘤坏死程度。结果研究组与对照组客观有效率相比,差异无统计学意义(P>0.05)。研究组Treg细胞比例由(5.75±1.85)%下降至(4.55±1.76)%,二者差异具有统计学意义(P<0.01);CD3+、CD4+、NK细胞比例及CD4+/CD8+分别由(52.24±12.56)%、(46.33±16.26)%、(17.72±6.89)%、1.25±0.66上升至(62.22±10.58)%(P<0.01)、(53.00±14.17)%(P<0.05)、(21.59±8.08)%(P<0.01)、1.57±0.70(P<0.01),CD8+由(43.95±13.78)%下降至(38.23±10.74)%(P<0.05)。对照组治疗前后Treg细胞比例及CD8+比例略有下降,CD3+、CD4+、NK细胞比例及CD4+/CD8+略有增加,但差异无统计学意义(P>0.05)。研究组中位生存期为18个月,明显高于对照组的12个月,二者差异具有统计学意义(P<0.05)。相关性分析显示:治疗后Treg细胞比例下降程度与生存期呈正相关关系(P<0.01)。结论 TRAE联合CIK细胞过继性免疫治疗中晚期肾癌能改善患者细胞免疫抑制状态,提高机体的抗肿瘤免疫效应,延长患者生存期。更多还原

【Abstract】 Objective To investigate the influence of TRAE and autologous cytokine induced killer(CIK) cells on the differentiation of regulatory CD4CD25+T cell(Treg),immune function and their implication in patients with advanced renal cell carcinoma(RCC).Materials and Methods A total of 65 patient with RCC were divided into resarch group(30 patients treaed with CIK cell thrapy after TRAE)and control group(35 patients treated only with TRAE).The levels of T lymphocyte subsets and native killer(NK) cell in peripheral blood of RCC patients before and after treatment were detected.Tumor condition was observed by CT,MRI or PET-CT 1 month after treatment.Results The therapeutic efficacy between two gtoups had no significant difference(P>0.05).In the resarch group,the percentages of Treg cells decreased from(5.75±1.85)% to(4.55±1.76)%(P<0.01)CD3+,CD4+,NK cells and the proportion of CD4+/CD8+ increased from(52.24±12.56)%,(46.33±16.26)%,(17.72±6.89)%,1.25±0.66 to(62.22±10.58)%(P<0.01),(53.00±14.17)%(P<0.05),(21.59±8.08) %(P<0.01),1.57±0.70(P<0.01),while CD8+ cells decreased from(43.95±13.78)% to(38.23±10.74)%(P<0.05).In the control group,the percentages of Treg,CD3+,CD4+,NK cells and the proportion of CD4+/CD8+ had no significant changes(P>0.05).The median survival of patients were 18 months vs.12 months(P<0.05).The decreasing extent of Treg is correlated with life time(P<0.01).Conclu-sion TRAE combined with autologous CIK cells transfusion should efficiently improve the immunological status in RCC patients,consequently prolonging the patients′survival.更多还原