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目的:探讨外周血免疫细胞亚群及血清肿瘤标记物对胃大部切除术后患者的预后预测的应用价值。方法:应用电化学发光免疫分析法及流式细胞术分别检测25例胃大部切除术后患者的相关血清肿瘤标记物(AFP、CEA、CA19-9、CA12-5、CA72-4)及外周血免疫细胞亚群CD3、NK、CD4、CD8、CD4/CD8,结合长期随访,采用统计学方法分析不同指标之间的相关性及其对胃大部切除术后患者预后预测的应用价值。结果:胃大部切除术后患者外周血免疫细胞亚群及血清肿瘤指标均存在异常,Mann-Whitney检验分析显示外周血CD4 T细胞亚群和CEA呈显著负相关(r=-0.460,P=0.014)。Kaplan-Meier生存分析显示胃大部切除术后患者CD4(P=0.021)和CA72-4(P=0.012)水平和患者预后明显相关。多因素Logistic分析显示CD4(P=0.008)和CA72-4(P=0.010)是影响胃大部切除术后患者预后的独立危险因素。结论:胃大部切除术后患者免疫细胞亚群及血清肿瘤标记物短期内仍存在异常,高水平CD4和低水平CD72-4与患者预后良好显著相关。
Objective: To investigate the value of peripheral blood immune cell subsets and serum tumor markers in predicting the prognosis of patients after subtotal gastrectomy. Methods: Electrochemiluminescence immunoassay and flow cytometry were used to detect serum tumor markers (AFP, CEA, CA19-9, CA12-5 and CA72-4) in 25 patients with subtotal gastrectomy and peripheral blood CD3, NK, CD4, CD8 and CD4 / CD8 were detected in long-term follow-up study. Statistical analysis was used to analyze the correlation between different indexes and their prognostic value in patients with subtotal gastrectomy. Results: Abnormalities of peripheral immune cell subsets and serum tumor markers were found after subtotal gastrectomy. Mann-Whitney test showed that there was a significant negative correlation between CD4 T cell subsets and CEA (r = -0.460, P = 0.014). Kaplan-Meier survival analysis showed significant correlation between CD4 (P = 0.021) and CA72-4 (P = 0.012) and prognosis in patients undergoing subtotal gastrectomy. Multivariate logistic analysis showed that CD4 (P = 0.008) and CA72-4 (P = 0.010) were independent risk factors for the prognosis of patients after subtotal gastrectomy. Conclusion: There are still some short-term abnormal immune cell subsets and serum tumor markers after subtotal gastrectomy. The high level of CD4 and low level of CD72-4 are significantly correlated with the prognosis of patients.