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目的:初步分析恶性肿瘤患者神经-内分泌-免疫网络紊乱情况及其临床意义。方法:102例经病理明确诊断的恶性肿瘤患者,用放射免疫法和流式细胞技术检测外周血中CD3+、CD4+和CD8+细胞数量、NK比值,以及IL-1β、IL-6、TNF-α、ACTH、CORT和DA及NE水平。结果:(1)在几乎所有类型肿瘤患者中都表现为CD3+、CD4+细胞数量下降(P<0.05或P<0.01)、CD8+的升高以及CD4+/CD8+的降低(P<0.05或P<0.01)。NK细胞在各恶性肿瘤组较正常均有下降(P<0.05)。肿瘤患者的IL-1β和TNF-α较正常均有不同程度的下降。与正常对照相比,IL-6在肿瘤患者中明显升高(P<0.05);各类型肿瘤间无明显差异(P>0.05)。ACTH在各组间无差异。皮质醇在消化道肿瘤患者中最高;明显高于脑瘤和肺癌患者(P<0.05)。DA和NE在大多数类型的恶性肿瘤患者组均升高(P<0.05或P<0.01)。(2)化疗和放疗患者组CD3+细胞数量较无化放疗者明显降低(P<0.05)。放疗患者组的CD8+升高及CD4+/CD8+比值下降较无放化疗组和化疗组明显,与无放化疗相比有统计学意义(P<0.05)。放疗患者IL-1β和IL-6值均升高,高于化疗者和无放化疗者(P<0.05);化疗患者TNF-α值较正常升高(P<0.05),与放疗者无明显差异。放疗患者组的DA水平低于无放化疗患者组(P<0.05)。(3)在女性肿瘤患者中,CD3+、IL-1β和TNF-α水平均高于男性(P<0.05)。(4)在恶性肿瘤包括有远处转移患者中,IL-6明显升高(P<0.05)。(5)一般状况差(PS:3～4级)患者的CORT和TNF-α升高明显(P<0.05)。而临床较晚期(Ⅲ～Ⅳ期)患者的CD4+/CD8+比值下降明显(P<0.05)。结论:恶性肿瘤患者神经-内分泌-免疫网络的紊乱,以皮质醇、TNF-α和IL-6及DA、NE水平不同程度的升高、以及CD3+、CD4+和CD4+/CD8+细胞数量不同程度的减少为主要表现,其与肿瘤患者的性别、病理类型、转移与否及其治疗方式等有关;与肿瘤患者的一般状况无关。
OBJECTIVE: To initially analyze the neuroendocrine-immune network disorder in patients with malignant tumors and its clinical significance. Methods: The number of CD3 +, CD4 + and CD8 + cells, NK ratio, IL-1β, IL-6 and TNF-α in peripheral blood were detected by radioimmunoassay and flow cytometry in 102 patients with malignant tumor with definite pathology. ACTH, CORT and DA and NE levels. Results: (1) CD3 + and CD4 + cells decreased (P <0.05 or P <0.01), CD8 + increased and CD4 + / CD8 + decreased in almost all types of cancer patients . NK cells in all malignant tumors were lower than normal (P <0.05). Tumor patients with IL-1β and TNF-α than normal decreased to some extent. Compared with the normal control, IL-6 was significantly increased in tumor patients (P <0.05). There was no significant difference between the various types of tumors (P> 0.05). There was no difference in ACTH between groups. Cortisol was highest in patients with digestive tract tumors; it was significantly higher than those in brain tumors and lung cancer patients (P <0.05). DA and NE were elevated in most types of malignant tumor patients (P <0.05 or P <0.01). (2) The number of CD3 + cells in chemotherapy and radiotherapy patients was significantly lower than that in patients without chemotherapy (P <0.05). Radiotherapy patients with elevated CD8 + and CD4 + / CD8 ratio decreased compared with non-chemoradiation chemotherapy and chemotherapy group was significantly (P <0.05) compared with no radiotherapy and chemotherapy. The levels of IL-1β and IL-6 in patients with radiotherapy were significantly higher than those in chemotherapy and non-radiotherapy (P <0.05). The patients with chemotherapy had higher levels of TNF-α than those in patients with radiotherapy (P <0.05) difference. The level of DA in radiotherapy patients was lower than that in patients without radiotherapy and chemotherapy (P <0.05). (3) The levels of CD3 +, IL-1β and TNF-α in female cancer patients were significantly higher than those in men (P <0.05). (4) IL-6 was significantly increased (P <0.05) in patients with malignant tumors including distant metastasis. (5) The general status of poor (PS: 3 to 4) patients with elevated CORT and TNF-α significantly (P <0.05). However, the ratio of CD4 + / CD8 + decreased significantly in patients with advanced stage Ⅲ ~ Ⅳ (P <0.05). CONCLUSIONS: The neuroendocrine-immune network disorder in patients with malignant tumors is characterized by varying degrees of elevation of cortisol, TNF-α and IL-6, DA and NE levels and the number of CD3 +, CD4 + and CD4 + / CD8 + As the main manifestation of cancer patients with their sex, pathological type, metastasis or not, and its treatment; has nothing to do with the general status of cancer patients.