许伦 李英 尤玮

【摘要】  目的  探討治疗前外周淋巴细胞亚群计数对晚期不可手术非小细胞肺癌（NSCLC）患者预后的预测价值。方法  收集2018年1月- 2020年1月医院确诊的98例Ⅲ～Ⅳ期不可手术的NSCLC患者，并收集同期50名健康体检者作为对照组。检验患者淋巴细胞亚群计数。病例组采用Kaplan-Meier 法计算患者总生存期，并用Log-rank检验进行比较。多因素分析采用Cox回归模型，评估治疗前外周血中T淋巴细胞亚群（CD3+T细胞、CD4+T细胞、CD8+T细胞、CD4+/CD8+T细胞）影响晚期不可手术NSCLC患者进展的因素。结果  与健康体检者相比，NSCLC患者的CD3+及CD8+明显低于健康对照组，CD4+/CD8+比值、NK细胞明显高于健康对照组，差异均有统计学意义（P<0.05）。多因素Cox回归分析结果表明，患者外周血的CD3+、CD8+、CD4+/CD8+水平对疾病进展有影响（P<0.05）。结论  治疗前患者外周血的CD3+、CD8+水平升高，CD4+/CD8+升高是影响患者进展的独立危险因素。

【关键词】  晚期非小细胞肺癌；淋巴细胞亚群；免疫；预后

中图分类号  R734.2    文献标识码  A    文章编号  1671-0223（2023）15--04

Influence of peripheral blood lymphocyte subsets on prognosis of patients with advanced non-small cell lung cancer  Xu lun， Li Ying， You Wei. Zigong Fourth People's Hospital， Zigong 643000， China

【Abstract】  Objective  To investigate the prognostic value of peripheral lymphocyte subsets before treatment in patients with advanced inoperable non-small cell lung cancer（NSCLC）. Methods  The clinical characteristics of 98 NSCLC patients diagnosed with stage Ⅲ-Ⅳ non-surgical NSCLC in the hospital from January 2018 to January 2020 were collected， and 50 healthy individuals in the same period as the control group. Test the patient's lymphocyte subpopulation count. The case group used the Kaplan-Meier method to calculate the total survival time of patients， and compared it with the Log-rank test. Multivariate analysis used Cox regression model to evaluate the factors that affect the progression of advanced non-surgical NSCLC patients with peripheral blood T lymphocyte subsets （CD3+T cells， CD4+T cells， CD8+T cells， CD4+/CD8+T cells） before treatment. Results  Compared with healthy individuals undergoing physical examination， the CD3+and CD8+levels in NSCLC patients were significantly lower than those in the healthy control group， while the CD4+/CD8+ratio and NK cells were significantly higher than those in the healthy control group， with statistical significance （P<0.05）. The results of multivariate Cox regression analysis showed that the levels of CD3+， CD8+， CD4+/CD8+in patients' peripheral blood had an impact on disease progression （P<0.05）. Conclusion  Before treatment， the levels of CD3+ and CD8+ in the patient's peripheral blood increased， and CD4+/CD8+ elevation is an independent risk factor affecting patient progression.

【Key words】   Advanced non-small cell lung cancer; Lymphocyte subsets; Immunity; Prognosis

肺癌是最常见的癌症，也是癌症相关死亡的主要原因[1]。非小细胞肺癌（NSCLC）占肺癌的75%，大多数诊断为晚期，其5年生存率仅为15%。据估计，2015年中国新增肺癌病例总数为733300例，肺癌死亡人数为610200例[2]。随着Burnet提出的肿瘤免疫监测理论的发展，对肿瘤免疫的研究不断深入，越来越多的研究者认识到肿瘤的发生发展与机体的免疫功能密切相关[3]。众所周知，癌症发展的每个阶段都极易受免疫细胞的调节。尽管针对肿瘤的适应性免疫细胞的充分激活可能导致恶性细胞的根除，但实际上，抗肿瘤细胞毒性T细胞活性和细胞因子介导的肿瘤细胞溶解抑制了肿瘤生长[4]。患者免疫系统对临床结果的潜在影响不仅具有学术意义，而且对于确定预测化疗和放疗反应的预后标志物也具有重要意义。……