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目的动态观察手术、化疗、免疫制剂对围手术期胃癌患者免疫功能的影响,并通过远期随访,探讨干扰素α1b(IFN-α1b)在胃癌综合治疗中的作用。方法获根治的49例胃癌患者分为:A组(单纯手术组,术前7天至术后4周内未给予化疗或IFN-α1b,10例);B组(化疗组,应用5-Fu,18例);C组(免化组,5-Fu+IFN-α1b,21例)。分别于术前,术后2周、4周、6周检测T细胞亚群(CD4、CD8)及NK细胞,监测肿瘤标志(TMs,包括胃癌抗原MG7、CEA、CA19-9),并对部分病例(应用IFN-α1b的IFN组,12例;对照组CTL组,包括单纯手术组及化疗组,11例)随访。结果胃癌患者术前免疫功能降低,术后短期内进一步削弱;化疗可损害免疫功能,加用IFN-α1b治疗6周以上可减轻免疫损伤;MG7的阳性率是69.4%,可作为判断预后的指标;术前TMs升高者术后短期内MG7下降,如联检则部分患者于术后3月TMs再度升高,但组间无差别;IFN组与CTL组的中位生存时间分别为44个月及30个月,但组间无差异(P=0.5641)。结论IFN-α1b可减轻化疗对机体的免疫损伤,但需较长时间才能发挥作用;IFN-α1b对胃癌患者的生存时间无明显影响;MG7在胃癌术后监测及随访方面有肯定价值。
Objective To observe the effects of surgery, chemotherapy and immune preparations on the immune function of patients with gastric cancer during the perioperative period and to explore the role of IFN-α1b in the comprehensive treatment of gastric cancer through long-term follow-up. Methods Forty-nine patients with gastric cancer who underwent radical operation were divided into two groups: group A (chemotherapy alone, no chemotherapy or IFN-α1b within 7 weeks before operation to 10 weeks); group B , 18 cases); group C (exempt group, 5-Fu + IFN-α1b, 21 cases). T cell subsets (CD4, CD8) and NK cells were detected preoperatively, 2 weeks, 4 weeks and 6 weeks after operation, and tumor markers (TMs, including gastric cancer antigens MG7, CEA and CA19-9) Cases (IFN-α1b IFN group, 12 cases; control group CTL group, including simple surgery group and chemotherapy group, 11 cases) were followed up. Results The preoperative immune function was decreased in patients with gastric cancer and was weakened shortly after operation. Chemotherapy could impair the immune function, and IFN-α1b treatment for more than 6 weeks could reduce the immune damage. The positive rate of MG7 was 69.4%, which could be used as a prognostic indicator ; Preoperative TMs increased MG7 decreased shortly after surgery, such as the joint test in some patients TMs again after March 3, but no difference between the two groups; IFN and CTL group median survival time was 44 months And 30 months, but no difference between groups (P = 0.5641). Conclusion IFN-α1b can reduce the immune damage caused by chemotherapy, but take a long time to play a role; IFN-α1b has no significant effect on the survival time of gastric cancer patients; MG7 has certain value in postoperative monitoring and follow-up of gastric cancer.