DC-CIK联合化疗治疗晚期胃癌患者临床疗效及免疫状态的研究

发布时间：2018-04-29 04:34

本文选题：DC-CIK + 化疗　；参考：《青岛大学》2017年硕士论文

【摘要】：消化道肿瘤常见的恶性肿瘤之一是胃癌,以手术治疗为主并结合传统放射治疗、化学治疗疗的综合治疗是当前治疗胃恶性肿瘤的主要方式。近些年来,研究表明,树突状细胞(dendritic cells,DCs)和细胞因子诱导的杀伤细胞(cytokine induced killer cells,CIK)共培养后得到的DC-CIK细胞,不仅增殖能力得到很好的加强同时对肿瘤的杀伤作用也得到大大提升。已经在血液系统肿瘤及一些实体瘤的治疗中进行了相关临床研究。目的:分析树突状细胞(Dendritic cells,DCs)及细胞因子诱导的杀伤细胞(Cytokine induced killer,CIK)联合化疗在免疫状态变化、近期临床疗效等方面对晚期胃癌患者的影响。同时记录不良反应。探索其成为临床治疗手段的可能性及安全性。方法:选取集青岛大学第二临床医学医学院(青岛市中心医院)的肿瘤数据库里的2011年2月-2015年11月符合入组条件的50例晚期胃恶性肿瘤患者。其中将行DC-CIK细胞免疫治疗联合化学治疗的25例晚期胃癌患者设为观察组,并选择同期临床资料相近的仅行化学治疗的25例晚期胃癌患者设为对照组。对照组25例,接受的治疗方式仅为单纯化疗;观察组25例,接受的治疗方式为DC-CIK细胞免疫治疗联合化疗治疗。采用流式细胞术的方法分别对两组患者治疗前后T细胞亚群(CD3+、CD4+及CD8+)的比例进行检测,采用ELISA法分别对两组治疗前后细胞因子IFN-γ、IL-12及IL-2的分泌水平进行检测。统一根据RECIST标准对两组患者进行临床疗效评价。所有数据采用SPSS17.0统计软件录入数据进行分析,计量资料以“(?)±s”表示,采用t检验进行两两分析,认为P0.05为差异有统计学意义。注意观察两组的不良反应。结果:观察组治疗后外周血中T细胞亚群CD4+、CD3+T细胞比值、细胞因子IFN-γ、IL-12较治疗前显著升高(P0.05),差异有统计学意义。对照组治疗后外周血中T细胞亚群CD8+T细胞比例较治疗前升高(P0.05),差异有统计学意义。而细胞因子IFN-γ较治疗前下降(P0.05),差异具有统计学意义。治疗后观察组和对照组的IL-2较治疗前比较均无显著性差异。观察组近期临床疗效较对照组有一定的改善,但无显著性差异(P0.05)。在行DC-CIK细胞回输的过程中及回输结束后未见明显不良反应。结论:DC-CIK细胞免疫治疗胃癌是有一定的近期临床疗效的,在改善患者的免疫功能方面具有一定的优势,且安全性较好。它有望成为晚期胃恶性肿瘤一种有效的过继免疫细胞治疗方法。
[Abstract]:Gastric cancer is one of the most common malignant tumors in digestive tract tumor. In recent years, it has been shown that the co-cultured DC-CIK cells derived from dendritic cells (DC) and cytokine induced killer cells (DC-CIK) not only enhance the proliferation ability, but also enhance the cytotoxicity to tumor. Clinical studies have been conducted in the treatment of hematologic tumors and some solid tumors. Aim: to investigate the effects of dendritic cells (DC) and cytokine induced cytotoxic induced killer (Cytokine induced kill CIK) combined chemotherapy on patients with advanced gastric cancer. Adverse reactions were also recorded. To explore the possibility and safety of clinical treatment. Methods: 50 patients with advanced gastric malignancy were selected from the tumor database of the second College of Clinical Medicine of Qingdao University (Qingdao Central Hospital) from February 2011 to November 2015. Among them, 25 patients with advanced gastric cancer who received DC-CIK cell immunotherapy combined with chemotherapy were selected as observation group, and 25 patients with advanced gastric cancer who had similar clinical data were selected as control group. The control group (25 cases) received chemotherapy alone, while the observation group (25 cases) received DC-CIK cell immunotherapy combined with chemotherapy. The ratio of CD4 and CD8 of T cell subsets before and after treatment were detected by flow cytometry, and the levels of cytokine IFN- 纬 IL-12 and IL-2 were detected by ELISA method before and after treatment. Two groups of patients were evaluated according to RECIST criteria. All the data were analyzed by SPSS17.0 statistical software, and the measurement data were expressed as "+ s". T test was used to analyze the data. The result showed that the difference was statistically significant (P0.05). The adverse reactions in both groups were observed. Results: the ratio of T cell subsets CD4 and CD3 T cells and the cytokine IFN- 纬 -IL-12 in the observation group were significantly higher than those before treatment (P 0.05). The percentage of CD8 T cells in peripheral blood of the control group was significantly higher than that before treatment (P 0.05). The level of cytokine IFN- 纬 was significantly lower than that before treatment (P 0.05). There was no significant difference in IL-2 between observation group and control group after treatment. The clinical effect of the observation group was improved to some extent than that of the control group, but there was no significant difference between the two groups (P 0.05). No significant adverse reactions were observed during and after DC-CIK cell retransfusions. Conclusion: the cell immunotherapy of gastric cancer with WDC-CIK has a certain clinical effect, and has some advantages in improving the immune function of patients, and the safety is good. It is expected to be an effective adoptive immune cell therapy for advanced gastric malignancies.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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