肺腺癌患者单孔胸腔镜肺叶切除术后早期外周血淋巴细胞亚群变化及其临床意义

doi:10.13481/j.1671-587x.20190323

摘要/Abstract

摘要： 目的：观察肺腺癌患者行单孔胸腔镜肺叶切除术后早期外周血T、B和NK淋巴细胞亚群变化，探讨其与患者临床病理参数的相关性及其可能的临床意义。方法：选取经单孔胸腔镜肺叶切除术治疗的肺腺癌患者66例，于入院当天（D0）、术后第1天（D1）和术后第5天（D5）分别抽取外周静脉血。采用血细胞计数仪和流式细胞术检测CD4+T、CD8+T、CD19+B和CD56+NK淋巴细胞百分比，计算手术前后患者T、B和NK淋巴细胞百分比的变化（ΔD0-1、ΔD0-5和ΔD1-5），分析其术后早期变化规律及与患者临床病理参数的关系。结果：与D0时比较，D1和D5时患者外周血中CD4+T、CD8+T、CD19+B和CD56+NK淋巴细胞百分比降低（P<0.01）；D5时患者外周血中CD4+T和CD8+T淋巴细胞百分比高于D1时（t=5.362，P<0.01；t=5.202，P<0.05）。D5与D1时患者CD19+B和CD56+NK淋巴细胞百分比比较差异无统计学意义（P>0.05）。D0和D5时非吸烟患者CD8+T淋巴细胞百分比明显高于吸烟患者（t=2.162，P<0.05；t=1.974，P<0.05），而D0时吸烟患者CD19+B细胞百分比明显高于非吸烟患者（t=-1.137，P<0.05）；D0时肿瘤T1期患者CD8+T淋巴细胞百分比明显高于T2-3期患者（t=1.684，P<0.05）；而D5时肿瘤T1期患者CD19+B淋巴细胞百分比明显高于T2~4期患者（t=1.431，P<0.05）；病理分期Ⅰ期患者CD19+B淋巴细胞百分比明显高于病理分期Ⅱ-Ⅲ期患者（t=2.134，P<0.05）。男性患者术后CD4+T淋巴细胞百分比变化（ΔD1-5）明显高于同期女性（t=1.707，P<0.05）；CD8+T淋巴细胞百分比变化（ΔD0-1和ΔD0-5）与肿瘤T分期呈负相关关系（r=-0.366，P<0.01；r=-0.252，P<0.05）；病理分期Ⅱ-Ⅲ期患者CD19+B淋巴细胞百分比变化（ΔD0-5和ΔD1-5）明显高于病理分期Ⅰ期患者（t=2.075，P<0.05；t=2.140，P<0.05）；CD56+NK淋巴细胞百分比变化（ΔD0-5）与患者年龄和吸烟状况有相关性，高龄患者（≥60岁）的ΔD0-5小于低龄患者（<60岁）（t=1.557，P<0.05），吸烟患者ΔD0-5小于不吸烟患者（t=-0.592，P<0.05）；患者CD56+NK淋巴细胞百分比变化（ΔD1-5）与肿瘤T分期呈负相关关系（r=-0.286，P<0.05）。结论：淋巴细胞亚群百分比的变化程度与患者年龄、性别、吸烟状况和肿瘤T分期有关。

关键词: 肺肿瘤, 腺癌, 单孔胸腔镜, 肺叶切除术, 淋巴细胞亚群, 免疫功能

Abstract: Objective:To observe the changes of T,B and NK lymphocyte subsets in peripheral blood of the patients with lung adenocarcinoma in the early stage after single-port thoracoscopic lobectomy, and to explore their relationships with the clinicopathological parameters of the patients and the possible clinical significances. Methods:A total of 66 patients with lung adenocarcinoma who underwent single-port thoracoscopic lobectomy were selected and the peripheral blood was respectively collected on the day of admission (D0),the 1st day (D1) and the 5th day (D5) after operation. The blood cell counter and flow cytometry were used to detect the percentages of CD4+T,CD8+T,CD19+B and CD56+NK lymphocytes. At the same time, the variations of cell percentages of T,B and NK lymphocytes (ΔD0-1,ΔD0-5 and ΔD1-5)before and after operation were calculated, respectively. The correlations between the changes of cell percentages (ΔD0-1,ΔD0-5 and ΔD1-5)of the patients in the early stage after operation and the clinicopathological parameters were analyzed. Results:Compared with D0, the percentages of CD4+T,CD8+T,CD19+B, and CD56+NK lymphocytes in peripheral blood of the patients on D1 and D5 were significantly decreased (P<0.01).The percentages of CD4+T and CD8+T lymphocytes on D5 were significantly higher than those on D1 (t =5.362, P<0.01;t=5.202,P<0.05). The percentages of CD19+B and CD56+NK lymphocytes showed a decreasing trend, but there were no significant differences in the percentages of CD19+B and CD56+NK lymphocytes of the patients between D5 and D1 (P>0.05). The percentage of CD8+ T cells in smokers was lower than that in non-smokers on D0 and D5 (t=2.162, P<0.05;t=1.974,P<0.05).The percentage of CD19+ B lymphocytes in smokers was higher than that in the non-smokers on D0 (t=-1.137,P<0.05). The percentage of CD8+ T lymphocytes in stage T1 was higher than that in stage T2-3 on D0 (t=1.684, P<0.05).The percentage of CD19+ B lymphocytes in stage T1 was higher than that in stage T2-3 (t=1.431, P<0.05), which was in stage Ⅰ higher than that in stage Ⅱ-Ⅲ on D5 (t=2.134, P<0.05).The variation in CD4 + T lymphocyte percentage of the male patients (ΔD1-5) was higher than that of the female patients (t=1.707,P<0.05).The variations in CD8+ T lymphocyte percentage (ΔD0-1 and ΔD0-5) had negative relationship with T stage(r=-0.366,P<0.01;r=-0.252,P<0.05). The variations in CD19+ B lymphocyte percentages (ΔD0-5 and ΔD1-5) of the patients in stage Ⅱ-Ⅲ were higher than those in stage Ⅰ (t=2.075,P<0.05;t=2.140,P<0.05). The variation of cell percentages of CD56+ NK lymphocytes(ΔD0-5) had significantly relationships with the age and smoking status of the patients.The ΔD0-5 in the older patients (≥ 60 years) was lower than that in the younger patients (< 60 years) and the ΔD0-5 in the smokers was lower than those in the non-smokers (t=1.557,P<0.05).The variation of lymphocyte percentage of CD56+ NK (ΔD1-5) had negative relationship with T stage (r=-0.592,P<0.05). Conclusion:The change degrees of percentages of lymphocyte subsets are correlated with the patients' age, gender, smoking status, and T stage.

Key words: lung neoplasms, adenocarcinoma, single-port thoracoscope, lobectomy, lymphocyte subsets, immune function

中图分类号:

R734.2

王上宁, 王思思, 田肃岩, 李佳林, 刘伟. 肺腺癌患者单孔胸腔镜肺叶切除术后早期外周血淋巴细胞亚群变化及其临床意义[J]. 吉林大学学报(医学版), 2019, 45(03): 606-613.

WANG Shangning, WANG Sisi, TIAN Shuyan, LI Jialin, LIU Wei. Early changes of peripheral blood lymphocyte subsets in patients with lung adenocarcinoma after single-port thoracoscopic lobectomy and their clinical significances[J]. Journal of Jilin University(Medicine Edition), 2019, 45(03): 606-613.

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