立体定向体部放射治疗（SBRT）对肺恶性肿瘤患者免疫功能的影响

发布时间：2018-04-02 06:42

本文选题：立体定向体部放射治疗　切入点：非小细胞肺癌　出处：《郑州大学》2017年硕士论文

【摘要】：目的本研究采用流式细胞术的方法,前瞻地研究接受SBRT早期及寡转移肺癌患者治疗前后外周血淋巴细胞亚群比例的变化,探讨SBRT对早期非小细胞肺癌及寡转移肺癌患者免疫功能的影响。材料与方法2015年10月至2017年1月,采集在河南省肿瘤医院放疗科接受SBRT的早期非小细胞肺癌及寡转移肺癌22例患者,其中男18例,女4例;中位年龄74岁(48-84岁)。I期肺癌14例,寡转移8例。放疗前0-7天,放疗后0-7天,放疗后4周分别采集外周血(可与入组常规采血一同进行),采用流式细胞术进行淋巴细胞亚群检测:CD3+(总T细胞,Total T lymphocytes),CD3+CD4+(T辅助/诱导细胞),CD3+CD8+(T抑制/细胞毒性细胞),CD4+CD25+(调节性T细胞,Regulatory T lymphocytes,Treg),CD8+CD28-(抑制性T细胞,Suppressive T lymphocytes,Ts),CD8+CD28+(细胞毒性T细胞,Cytotoxic T lymphocytes,Tc),CD4+/CD8+(CD4+与CD8+亚群比值)。采用SPSS22.0软件进行统计学分析,分类变量由频数和百分比描述。连续变量由平均数±标准差描述。采用配对t检验对比治疗前后自身淋巴细胞亚群比例的变化。P0.05为具有统计学差异。结果1.入组22例患者均放疗前0-7天及放疗后0-7天均进行了淋巴细胞亚群检测,其中11例患者放疗后4周进行淋巴细胞亚群检测;2.22例患者放疗前0-7天与放疗后0-7天比,除CD3+放疗后较放疗前增加(P=0.023),其他淋巴细胞亚群比例变化不明显(P0.05);3.11例患者放疗后4周进行淋巴细胞亚群检测,患者淋巴细胞亚群与放疗之前淋巴细胞亚群比变化不明显(P0.05),见表8;4.对于13例早期原发非小细胞肺癌患者,放疗前0-7天与放疗后0-7天比,各淋巴细胞亚群变化均不明显(P0.05);5.对于9例肺部寡转移患者,放疗前0-7天与放疗后0-7天比,CD3+放疗后较放疗前增加(P=0.027),CD3+CD4+放疗后较放疗前增加(P=0.038),CD4+CD25+放疗后较放疗前增加(P=0.032),其他淋巴细胞亚群比例变化不明显(P0.05)。结论SBRT治疗对于肺部肿瘤患者免疫功能影响不大,可以认为对于因高龄或合并严重心、肺等内科疾病不能或不愿接受手术的患者其是一种安全有效的治疗手段。对于肺部寡转移的患者,对其进行SBRT治疗后,可能会引起免疫功能改变,可能与局部免疫反应有关。另外,SBRT治疗可能引起肿瘤局部免疫反应,具体的检测生物学标记、检测方法以及检测时机有待进一步研究。
[Abstract]:Objective to study the changes of lymphocyte subsets in peripheral blood of patients with early SBRT and oligometastasis lung cancer before and after treatment with flow cytometry. To investigate the effect of SBRT on immune function in patients with early non-small cell lung cancer and oligometastasis lung cancer. Materials and methods from October 2015 to January 2017, Twenty-two patients with early non-small cell lung cancer (NSCLC) and oligometastasis lung cancer (18 males and 4 females) received SBRT in radiotherapy Department of Henan Cancer Hospital, 14 patients with stage I lung cancer aged from 74 to 84 years old and 8 patients with oligometastases were enrolled. 0-7 days after radiotherapy, Four weeks after radiotherapy, peripheral blood was collected separately (which can be taken together with routine blood collection). The lymphocyte subsets were detected by flow cytometry. Total T lymphocytes were detected by total T lymphocyte lymphocyte subsets. CD3 CD8 T suppression / cytotoxicity was detected by T assisted / induced cells. The ratio of CD4 / CD8 CD25 (cytotoxic T lymphocytes) to CD _ 4 / CD _ 8 (CD _ 4 / CD _ 8 / CD8) subsets were analyzed by SPSS22.0 software, and the ratio of CD _ 4 / CD _ 8 / CD _ 8 / CD _ 8 / CD _ 8 / CD _ 8 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 subsets were analyzed by SPSS22.0 software. The classification variable is described by frequency and percentage. The continuous variable is described by mean 卤standard deviation. The ratio of autologous lymphocyte subsets before and after treatment is compared by paired t test. Results 1. Lymphocyte subsets were detected 0-7 days before radiotherapy and 0-7 days after radiotherapy in 22 patients. Lymphocyte subsets were detected in 11 patients at 4 weeks after radiotherapy compared with 0-7 days before radiotherapy and 0-7 days after radiotherapy in 2.22 patients. The lymphocyte subsets were detected 4 weeks after radiotherapy in 3. 11 patients with CD3, except for the increase of P0. 023 after radiotherapy. The ratio of lymphocyte subsets to lymphocyte subsets before radiotherapy in 13 patients with early non-small cell lung cancer (NSCLC) was not significantly different from that before radiotherapy (P 0.05), as shown in Table 8 (4). For 13 patients with early non-small cell lung cancer (NSCLC), the ratio of 0 to 7 days before radiotherapy was higher than that of 0 to 7 days after radiotherapy. The changes of lymphocyte subsets were not significant in 9 patients with pulmonary oligometastasis. 0 to 7 days before radiotherapy and 0 to 7 days after radiotherapy, there was an increase in P0. 027 CD4 after radiotherapy and 0-7 days after radiotherapy compared with that before radiotherapy. After radiotherapy, there was an increase of P0. 032, P0. 032, and the proportion of other lymphocyte subsets in lung after radiotherapy. Conclusion SBRT treatment has no significant effect on pulmonary lung. The immune function of tumor patients was not affected. It can be considered as a safe and effective treatment for patients who are unable or unwilling to undergo surgery because of advanced age or severe heart disease. For patients with pulmonary oligometastasis, after SBRT treatment, In addition, SBRT treatment may cause local immune response of tumor. The specific detection of biological markers, detection methods and detection timing need to be further studied.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R730.55

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