中国普外基础与临床杂志

中国普外基础与临床杂志

新辅助化疗对乳腺癌患者 T 淋巴细胞亚群及 NK 细胞的影响

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目的 探讨新辅助化疗对乳腺癌患者 T 淋巴细胞亚群及自然杀伤细胞(NK 细胞)的影响。 方法 前瞻性收集 2015 年 5 月至 2017 年 1 月期间于笔者所在医院行新辅助化疗的 68 例乳腺癌患者作为病例组,并匹配收集同期于笔者所在医院行体检的 68 例健康体检者作为对照组。病例组患者术前及术后共接受 6 个周期的化疗。分别于化疗前(对照组于入组时)和化疗 4 个周期(对照组同匹配患者间隔相同时间)后,采用流式细胞仪检测病例组和对照组的 T 细胞亚群比例和 NK 细胞比例。于化疗 4 个周期结束后对病例组患者的疗效进行评价,根据疗效分为有效组和无效组,比较不同疗效组患者外周血中的 T 淋巴细胞亚群比例和 NK 细胞比例。 结果 化疗前与对照组比较,病例组患者的 CD4+T 细胞比例、CD4+T 细胞/CD8+T 细胞比值及 NK 细胞比例均较低高(P<0.05),CD8+T 细胞比例较高(P<0.05)。与化疗前比较,病例组患者化疗后 CD8+T 细胞比例降低,CD4+T 细胞比例、CD4+T 细胞/CD8+T 细胞比值及 NK 细胞比例均升高(P<0.05)。病例组和对照组化疗前后的 CD4+T 细胞比例的差值、CD8+T 细胞比例的差值、CD4+T 细胞/CD8+T 细胞比值的差值及 NK 细胞比例的差值比较差异均有统计学意义(P<0.05),病例组的改变值大于对照组。68 例乳腺癌患者经过 4 个周期的新辅助化疗后,有效 44 例(有效组),无效 24 例(无效组)。与化疗前比较,有效组患者化疗后的 CD8+T 细胞比例降低,CD4+T 细胞比例、CD4+T 细胞/CD8+T 细胞比值及 NK 细胞比例均升高(P<0.05)。有效组和无效组患者化疗前后的 CD4+T 细胞比例的差值、CD8+T 细胞比例的差值、CD4+T 细胞/CD8+T 细胞比值的差值及 NK 细胞比例的差值比较差异均有统计学意义(P<0.05),有效组的改变值大于无效组。 结论 乳腺癌患者外周血中的 CD4+T 细胞和 NK 细胞比例较低,而 CD8+T 细胞比例较高,有效的新辅助化疗有助于提高患者的 CD4+T 细胞和 NK 细胞比例,并降低 CD8+T 细胞比例,改善患者的免疫功能。

Objective To explore the effect of neoadjuvant chemotherapy on the T lymphocyte subsets immunity and natural killer cells in patients with breast cancer. Methods Sixty-eight patients with breast cancer who received neoadjuvant chemotherapy in our hospital from May 2015 to January 2017 were selected as the case group, then matched with 68 healthy persons as control group. Patients in the case group received six cycles of neoadjuvant chemotherapy. The proportion of T lymphocyte subsets immunity (CD3+T lymphocytes, CD4+T lymphocytes, and CD8+T lymphocytes) and NK cells in the 2 groups before (persons in control group were tested at enrolled time) and after chemotherapy (persons in control group were tested at the same time with the matched patient) was tested with flow cytometry. The curative effect was evaluated and divided into effective group and ineffective group according to the curative effect after neoadjuvant chemotherapy, and the proportion of T lymphocytes subsets immunity and NK cells was compared also. Results Compared with control group before neoadjuvant chemotherapy, the proportion of CD4+T lymphocytes and NK cells, as well as the ratio of CD4+T lymphocytes/CD8+T lymphocytes was lower (P<0.05), and the proportion of CD8+T lymphocytes was higher (P<0.05). Compared with before neoadjuvant chemotherapy, the proportion of CD8+T lymphocytes decreased, but the proportion of CD4+T lymphocytes and NK cells, as well as the ratio of CD4+T lymphocytes/CD8+T lymphocytes in the case group increased (P<0.05). The difference between before and after neoadjuvant chemotherapy of proportion in CD4+T lymphocytes, CD8+T lymphocytes, and NK cells, as well as the ratio of CD4+T lymphocytes/CD8+T lymphocytes in the case group were greater than those in the control group (P<0.05). There were 44 patients enrolled in the effective group and 24 patients enrolled in the ineffective group according to the curative effect. Compared with before neoadjuvant chemotherapy, the proportion of CD8+T lymphocytes decreased, but the proportion of CD4+T lymphocytes and NK cells, as well as the ratio of CD4+T lymphocytes/CD8+T lymphocytes in the effective group increased (P<0.05). The difference between before and after neoadjuvant chemotherapy of proportion in CD4+T lymphocytes, CD8+T lymphocytes, and NK cells, as well as the ratio of CD4+T lymphocytes/CD8+T lymphocytes in the effective group were greater than those in the ineffective group (P<0.05). Conclusions The proportion of CD4+T lymphocytes and NK cells in patient with breast cancer is low, while the proportion of CD8+T lymphocytes is high, comparing with healthy person. The immune function improves after effective neoadjuvant chemotherapy, with the proportion of CD4+T lymphocytes and NK cells increase and proportion of CD8+T lymphocytes decrease.

关键词: 乳腺癌; 新辅助化疗; T 淋巴细胞亚群; 自然杀伤细胞

Key words: breast cancer; neoadjuvant chemotherapy; T lymphocyte subsets immunity; natural killer cells

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