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目的探讨肿瘤负荷对于大肠癌患者外周血 T1(分泌Ⅰ类因子 T 细胞)、T2(分泌Ⅱ类因子 T 细胞)分化的影响及其临床意义。方法连续采集20例大肠癌患者(17例行根治术、3例行姑息切除术)初诊时及去除瘤负荷后第7天外周血,同期年龄、性别匹配的20例良性疾病患者外周血作为对照。应用胞内因子检测法检测 T1、T2;应用流式细胞术检测淋巴细胞亚群(T、CD4~+T、CD8~+T、B、NK)。结果大肠癌患者外周血 T1、T2明显低于对照组(P=0.006,0.017);淋巴细胞亚群无明显改变。去除肿瘤负荷后7 dT1升高(P>0.05),T2明显升高(P=0.020)。肿瘤直径≥5 cm 及低分化癌患者的 T1分别低于肿瘤直径<5 cm 及高、中分化癌患者(P=0.064,0.072);有淋巴结转移患者的T1明显低于无淋巴结转移患者(P=0.033);Ⅲ+Ⅳ期患者的 T1明显低于Ⅰ+Ⅱ期患者(P=0.033)。结论肿瘤负荷可以显著抑制大肠癌患者外周血 T1、T2的分化,这是导致机体抗肿瘤免疫功能低下的机制之一;去除肿瘤负荷后短时间内 T1、T2即开始升高,免疫功能得到一定的改善;T1可能是一种新的大肠癌预后指标。
Objective To investigate the effect of tumor burden on the differentiation of T1 (secreting class I T cells) and T2 (secretory class Ⅱ T cells) in peripheral blood of patients with colorectal cancer and its clinical significance. Methods Peripheral blood samples were collected from 20 patients with colorectal cancer (17 underwent radical resection and 3 underwent palliative resection) and 20 patients with benign disease on the 7th day after removal of tumor load . T 1 and T 2 were detected by intracellular factor test. Lymphocyte subsets (T, CD4 ~ + T, CD8 ~ + T, B and NK) were detected by flow cytometry. Results The peripheral blood T1 and T2 in patients with colorectal cancer were significantly lower than those in the control group (P = 0.006, 0.017). There was no significant change in lymphocyte subsets. At 7 days after tumor load removal, the levels of Tl1 increased (P> 0.05) and T2 increased (P = 0.020). T1 of tumor with diameter> = 5 cm and poorly differentiated cancer were lower than those with tumor diameter <5 cm and high or moderate differentiation (P = 0.064, 0.072), respectively; T1 with lymph node metastasis was significantly lower than that without lymph node metastasis = 0.033). The T1 of stage Ⅲ + Ⅳ patients was significantly lower than that of stage Ⅰ + Ⅱ patients (P = 0.033). Conclusion Tumor burden can significantly inhibit the differentiation of T1 and T2 in the peripheral blood of patients with colorectal cancer, which is one of the mechanisms leading to the low antitumor immune function in the patients. Tl and T2 began to increase within a short time after removal of tumor burden, and the immune function was certain T1 may be a new prognostic indicator of colorectal cancer.