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目的观察放疗前食管癌患者的免疫应激状态,探讨其与食管癌患者临床病理特征及预后的关系。方法 91例经病理组织学确诊的食管癌患者均行放射治疗,使用流式细胞仪测定其治疗前外周血T淋巴细胞亚群及自然杀伤(NK)细胞比例,以健康体检人群为对照观察其变化。分析放疗前免疫应激状态与食管癌患者临床病理参数之间的关系;采用单因素分析(Kaplan-Meier)法和多因素分析(Cox比例风险模型)法研究食管癌患者预后的影响因素。结果食管癌患者放疗前外周血CD3+CD4+(Th)T细胞、CD8+CD28+T细胞及NK细胞的比例较正常对照组明显下降(P<0.05)。与临床病理特征的相关性分析提示:CD3+CD8+(Ts)T淋巴细胞亚群比例则与淋巴结转移相关,而NK细胞与TNM分期相关(P<0.05)。单因素生存分析显示:Th细胞比例或CD8+CD28+T淋巴细胞比例高的食管癌患者其总体生存率要好于低比例患者(P<0.05);Cox模型多元回归分析结果显示:外周血Th细胞比例是预测食管癌患者生存的独立预后因素。结论放疗前外周血Th细胞比例可能有助于判断食管癌患者临床预后。
Objective To observe the status of immune stress in patients with esophageal cancer before radiotherapy and to explore its relationship with the clinicopathological features and prognosis of patients with esophageal cancer. Methods 91 cases of pathologically diagnosed esophageal cancer patients underwent radiotherapy, the use of flow cytometry before treatment to determine the proportion of peripheral blood T lymphocyte subsets and natural killer (NK) cells to healthy people as a control group observed Variety. The relationship between the immune state and the clinicopathological parameters of patients with esophageal cancer before radiotherapy was analyzed. The factors influencing the prognosis of patients with esophageal cancer were analyzed by Kaplan-Meier method and multivariate analysis (Cox proportional hazards model). Results The proportion of CD3 + CD4 + (Th) T cells, CD8 + CD28 + T cells and NK cells in peripheral blood of patients with esophageal cancer before radiotherapy was significantly lower than that of the normal control group (P <0.05). Correlation analysis showed that the proportion of CD3 + CD8 + (Ts) T lymphocyte subsets correlated with lymph node metastasis, while NK cells correlated with TNM staging (P <0.05). Univariate survival analysis showed that the overall survival rate of esophageal cancer patients with high proportion of Th cells or CD8 + CD28 + T lymphocytes was better than that of low proportion patients (P <0.05). Multiple regression analysis of Cox model showed that peripheral blood Th cells Proportions are independent predictors of survival in esophageal cancer patients. Conclusion The proportion of Th cells in peripheral blood before radiotherapy may be helpful in judging the prognosis of esophageal cancer patients.