【摘要】 目的:探讨进展期食管胃交界部腺癌(AEGJ)患者围手术期外周血中淋巴细胞亚群及CD4~+CD25~+T细胞和程序性细胞死亡1(PD-1)在T淋巴细胞中表达的变化,了解根治性手术创伤对机体细胞免疫功能的影响及机制。方法:126例进展期食管胃交界部腺癌行开腹根治性R0切除+D2淋巴结清除术,同期体检志愿者87例为对照组。应用流式细胞仪检测对照组和治疗组术前、术后1天、术后3天、术后7天和术后9天外周血CD3~+、CD3~+CD4~+、CD3~+CD8~+、CD4~+CD25~+T细胞计数和PD-1在T细胞中的表达水平。结果:治疗组术前和对照组相比较,CD3~+、CD3~+CD4~+T细胞均显著降低(P<0.05),而CD4~+CD25~+T细胞和PD-1在CD4~+、CD8~+T细胞的表达比例均显著增高(P<0.05)。CD4~+CD25~+T细胞的比例在术后1天迅速下降至谷底,随后逐渐升高,于术后7天达顶峰,然后再次下降。CD4~+PD-1~+T细胞的比例在术后显著增加:术后第1天达到最大值,然后逐渐下降,但在术后第7天仍显著高于术前。CD8~+PD-1~+T细胞的比例则在术后逐渐增加,到术后7天达高峰。结论:食管胃交界部腺癌手术创伤可能是通过各种细胞因子导致CD4~+PD-1~+T细胞比例改变,进而调节T淋巴细胞亚群比例,抑制细胞免疫能力。更多还原

【Abstract】 Objective:To evaluate cells ratios of T lymphocyte subsets and expression of programmed cell death 1(PD-1) in lymphocytes following surgery for advanced adenocarcinoma of esophagogastric junction(AEGJ),and to understand the effect of radical surgical trauma on cellular immune function.Methods:In 126 patients with advanced AEGJ,radical open abdominal R0 resection and D2 lymphnode dissection were performed,while 87 patients with concurrent physical examination were in the control group.Peripheral blood levels of CD3~+,CD3~+CD4~+,CD3~+CD8~+,CD4~+CD25~+T lymphocyte and expression of PD-1 in lymphocytes were measured by flow cytometry in the control group and the treatment group obtained pre-and post-operatively.Results:Compared with control group,preoperative ratios of CD3~+,CD3~+CD4 T cells were significantly reduced(P<0.05),and CD4~+CD25~+T cells ratio add PD-1 ration in CD4~+,CD8~+T cells were significantly increased(P<0.05).CD4~+CD25~+T lymphocyte count decreased rapidly from preoperative levels,reaching a minimum on post-operative day 1 and remaining significantly increased on days 3 and 7.CD4~+PD-1~+T lymphocytes significantly increased,reaching a maximum on postoperative day 1 and remaining significantly elevated on day 3.CD8~+PD-1~+T lymphocytes significantly increased and reached a maximum on day 7.Conclusion: Surgical trauma of AEGJ may be caused by changes in the proportion of CD4~+ PD-1~+T lymphocytes caused by various cytokines,thereby regulating the proportion of T lymphocyte subsets and inhibiting the cellular immunity.更多还原