微粒-TACE治疗肝癌患者术后外周血中GPC3-CTLs变化研究

发布时间：2018-03-09 22:16

  本文选题：肝细胞癌　切入点：明胶海明微粒　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:应用明胶海绵微粒经导管肝动脉化疗栓塞术(GSMs-TACE)治疗肝细胞癌(HCC),探讨该方法对肝癌患者外周血中GPC3特异性细胞毒性T淋巴细胞(GPC3-CTLs)频数及百分率影响和临床意义。方法:选择符合入组标准11例HCC患者行GSMs-TACE治疗,5例HCC患者行外科手术切除治疗作为对照组,9例健康人为健康对照组。所有患者在术前1天及术后4天、10天、20天常规行肿瘤标志物(AFP、PIVKA-Ⅱ)及各种生化检查,术后4天、30天分别行上腹部CT平扫及增强CT检查。于术前1天、术后10、20天采集前臂外周静脉血2m L,正常对照组采集静脉血2ml。应用HLA-A基因分型法、四聚体技术、流式细胞技术检测外周血GPC3-CTLs频数及百分率。结果:应用流式细胞仪检测外周血中GPC3-CTLs频数及GPC3-CTLs百分率,与正常对照组相比,GSMs-TACE治疗组GPC3-CTLs频数及百分率明显升高,差异有统计学意义(p0.05)。HCC患者行GSMs-TACE治疗后10、20天外周血中GPC3-CTLs频数和百分率变化与术前比较差异有统计学意义(p0.05)。并且GSMs-TACE术后10天GPC3-CTLs频数及百分率与术前相比明显增高,并出现峰值,术后20天指标虽然下降但仍大于术前水平。外科手术对照组术前与术后10、20天外周血中GPC3-CTLs频数和百分率变化比较差异有统计学意义(p0.05)。GPC3-CTLs频数和百分率较术前逐渐下降。HCC患者ALT、AST以及TBIL指标均在术后第4天升高,随后逐渐下降至正常范围,ALT、TBIL术后第10、20天与术前相比较均无统计学差异(p0.05),AST术后20天与术前比较无统计学差异(p0.05),ALB术后4天、10天、20天与术前比较差异无统计意义(p0.05)。AFP、PIVKA-Ⅱ术后4天、10天、20天较术前比较明显下降,且呈进行性下降趋势,差异有统计意义p0.05)。结论:GSMs-TACE治疗HCC后,促进外周血GPC3-CTLs频数及百分率增加,初步证实GSMs-TACE方法可以激活机体内源性抗肿瘤特异性免疫反应;GSMs-TACE能促进HCC患者外周血GPC3-CTLs频数及百分率增加,与该方法造成肿瘤大范围坏死有关。
[Abstract]:Objective: to study the effect of gelatin sponge particles transcatheter hepatic arterial chemoembolization (GSMs-TACEE) on the frequency and percentage of GPC3 specific cytotoxic T lymphocytes in peripheral blood of patients with hepatocellular carcinoma (HCC) and its clinical significance. Methods: 11 patients with HCC were treated with GSMs-TACE and 5 patients with HCC were treated with surgical resection as control group. 9 healthy persons were selected as control group. All patients were treated with GSMs-TACE before operation and 4 days after operation. All kinds of biochemical tests were performed. The peripheral venous blood of forearm was collected 1 day before operation and 1020 days after operation, and 2 ml of venous blood was collected in normal control group. HLA-A genotyping method and tetramer technique were used. Results: the frequency and percentage of GPC3-CTLs and GPC3-CTLs in peripheral blood were detected by flow cytometry. Compared with the control group, the frequency and percentage of GPC3-CTLs in GSMs-TACE treatment group were significantly increased. There was significant difference in the frequency and percentage of GPC3-CTLs in peripheral blood of patients with GSMs-TACE 10 ~ 20 days after GSMs-TACE treatment, and there was a significant difference in the frequency and percentage of GPC3-CTLs between 10 days after GSMs-TACE and 10 days after GSMs-TACE, and there was a peak value in the frequency and percentage of GPC3-CTLs at 10 days after GSMs-TACE. The frequency and percentage of GPC3-CTLs in peripheral blood of the surgical control group was significantly lower than that of the preoperative control group, and the frequency and percentage of GPC3-CTLs in the peripheral blood of the surgical control group were decreased gradually compared with those before the operation. The levels of alt and TBIL in HCC patients increased on the 4th day after operation. Then it gradually decreased to the normal range. There was no statistical difference between 10 and 20 days after operation. There was no statistical difference between 20 days after operation and 20 days after operation. There was no statistical difference between before and after operation. There was no statistical difference between before and after 4 days, 10 days and 20 days after ALB. AFPPIVKA- 鈪，

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