王立静，苗同国，宁更献，张建集，蔡丽芬

肝动脉化疗栓塞术对原发性肝癌患者T淋巴细胞亚群的影响

王立静，苗同国，宁更献，张建集，蔡丽芬

目的探讨肝动脉化疗栓塞术（TACE）前后原发性肝癌（PHC）患者T细胞亚群的变化。方法采用流式细胞术（FCM）检测PHC患者TACE术前1 d与术后1、2、3和4周外周血CD3、CD4、CD8 T细胞及CD4/CD8、CD4CD25/CD4的比值变化。结果PHC患者术前外周血T细胞亚群CD3、CD4、CD4/ CD8比值显著低于健康对照组，CD8则明显高于健康对照组（P＜0.05）；治疗1周后外周血T细胞亚群指标较治疗前明显下降（P＜0.05），而4周后外周血T细胞亚群CD3、CD4、CD8及CD4/CD8比值较治疗前显著增高（P＜0.05）。PLC患者外周血中CD4CD25/CD4 T细胞的比例显著高于健康对照组，与术前比较，术后1、2周外周血CD4CD25/CD4 T细胞的比例明显升高，术后4周外周血CD4CD25/CD4 T细胞的比例显著下降。结论TACE可以改善PHC患者的免疫状况。

原发性肝癌；肝动脉化疗栓塞术；T细胞亚群；细胞免疫功能

【Abstract】ObjectiveTo investigate the changes of T lymphocyte subsets in patients with primary hepatocellular carcinoma（HCC）after transcatheter arterial chemoembolization（TACE）.MethodsA total of 40 patients with pathologically-proved HCC（study group）were enrolled in this study.Other 40 healthy volunteers were randomly collected and used as control group.Peripheral blood CD3，CD4 and CD8 T cells as well as CD4/CD8，CD4CD25/CD4 ratio were determined one day before TACE and one，2，3 and 4 weeks after TACE were determined in all patients by using flow cytometry assay.The results were statistically analyzed.ResultsThe preoperative peripheral T lymphocyte subsets CD3，CD4 T cells and CD4/CD8 ratio in the study group were significantly lower than those in the control group，while CD8 T cells in the study group were significantly higher than that in the control group（P＜0.05）.One week after treatment，the indexes of peripheral T lymphocyte subsets in the study group were obviously decreased when compared with the preoperative data（P＜0.05），and 4 weeks after the treatment the peripheral T lymphocyte subsets，including CD3，CD4 and CD8 T cells as well as CD4/CD8 ratio，were significantly increased when compared with the preoperative data（P＜0.05）.The peripheral CD4CD25/CD4 ratio in the study group was much higher than that in the control group.In the study group，the peripheral CD4CD25/CD4 ratio determined at one and 2 weeks after the treatment was strikingly increased when compared with preoperative data；and four weeks after the treatment，the peripheral CD4CD25/CD4 ratio was dramatically decreased（P＜0.05）.Conclusion TACE can improve the immune status of HCC patients.（J Intervent Radiol，2015，24：165-168）

【Keywords】primaryhepatocellularcarcinoma；transcatheterarterialchemoembolization；T lymphocyte subsets；cellular immune function

原发性肝癌（primary hepatic carcinomas，PHC）是原发于肝脏的恶性上皮细胞肿瘤，主要包括肝细胞癌、肝内胆管癌以及肝细胞和肝内胆管混合癌，是临床常见恶性肿瘤，病死率高，占我国恶性肿瘤死亡率第2位。PHC起病隐匿、发展快，一经发现多为中晚期，失去手术机会。肝动脉栓塞化疗（TACE）适应证较广，与传统的手术切除相比具有创伤小，费用低的优势，已成为中晚期肝癌的主要治疗手段。其基本的治疗原理是栓塞肿瘤供血动脉致肿瘤坏死。研究证实，肝癌的发生进展及预后与肿瘤局部微环境和全身免疫功能状态密切相关，肝癌组织坏死后释放的肿瘤抗原可诱导抗肿瘤特异性T淋巴细胞免疫反应［1-2］。……