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目的探讨围手术期使用西米替丁对大肠癌根治术后患者全身及局部免疫的调节作用及其临床意义。方法将行大肠癌根治术的患者随机分为实验组 (n =40 )和对照组 (n =40 )。实验组术前 1周开始至术后第 14天使用西米替丁 1 2g/d ;对照组不使用西米替丁或类似药物。两组患者均于术前第 3天、术后第 7天及第 14天采血 ,检测T细胞亚群及白介素 2 (interleukin 2 ,IL 2 )、γ 干扰素 (interferon γ ,IFN γ)活性的变化 ,并于切除标本中检测肿瘤浸润淋巴细胞 (tumor infiltratinglympho cyte ,TIL)反应。结果实验组术后第 7天各项指标已恢复到术前水平。术后第 14天辅助性T细胞(CD4 ) /抑制性T细胞 (CD8)比值、IL 2及IFN γ活性比对照组及本组术前水平均有明显升高 (P <0 0 5 ) ,且TIL反应的阳性率显著高于对照组 (P <0 0 1) ,术后 3年、5年生存率较高 (P <0 0 5 )。结论西米替丁可明显减轻大肠癌患者围手术期细胞免疫抑制程度 ,缩短其术后免疫抑制周期 ,并可提高TIL反应
Objective To investigate the effect and clinical significance of perioperative use of cimetidine on systemic and local immune in patients with colorectal cancer after radical operation. Methods Patients with colorectal cancer undergoing radical operation were randomly divided into experimental group (n = 40) and control group (n = 40). In the experimental group, cimetidine 12 g / d was given from the first week before operation to the 14th day after operation. Cimetidine or similar drugs were not used in the control group. Blood samples were taken from the third day, the seventh day and the fourteenth day after operation in both groups to detect the T cell subsets and the activity of interleukin 2 (IL 2), interferon γ (IFN γ) Changes were detected in tumor specimens and the tumor infiltrating lymphocyte (TIL) response was detected. Results The experimental group on the 7th day after the index has returned to the preoperative level. On the 14th day after operation, the ratio of CD4 + T cells (CD8), IL2 and IFNγ were significantly higher than those in the control group and the preoperative group (P <0.05) The positive rate of TIL was significantly higher than that of the control group (P <0.01). After 3 years, the 5-year survival rate was higher (P <0.05). Conclusion Cimetidine can significantly reduce perioperative immunosuppression in patients with colorectal cancer, shorten the postoperative immunosuppressive cycle, and can improve the TIL response