發(fā)布時(shí)間：2019-01-02 08:12

【摘要】：目的:分析新疆維吾爾、漢族鼻咽癌患者HLA等位基因多態(tài)性、LMP2A特異性T細(xì)胞免疫反應(yīng)、預(yù)后及影響因素的差異。方法:收集新疆腫瘤醫(yī)院2011年1月~2014年12月的初治鼻咽癌患者外周血標(biāo)本,提取DNA,PCR-SSP法檢測HLA等位基因;分離外周血單個(gè)核細(xì)胞,ELISPOT法檢測治療前及治療結(jié)束后3個(gè)月LMP2A特異性T細(xì)胞免疫反應(yīng);回顧分析181例初治行IMRT治療的鼻咽癌患者臨床資料,分析預(yù)后及其影響因素。結(jié)果:新疆維吾爾、漢族鼻咽癌患者HLA等位基因分布及頻率存在差異,維吾爾族鼻咽癌患者HLA-B46、C06、DQB107、DRB102等位基因頻率高于漢族患者(P0.05);維吾爾族鼻咽癌患者HLA-A02、A03、C01、DQB108、DQB109等位基因的頻率低于漢族患者(P0.05);維吾爾族鼻咽癌的易感基因?yàn)镠LA-C14(P=0.041);漢族鼻咽癌的易感基因?yàn)?HLA-A02、B46、C01;保護(hù)基因?yàn)?HLA-A30、B13。初治患者LMP2A特異性T細(xì)胞免疫應(yīng)答明顯低于健康對照;維吾爾族患者在不同年齡、T分期組特異性T細(xì)胞反應(yīng)有差異,漢族患者在不同N分期、HLA-A02等位基因攜帶組特異性T細(xì)胞反應(yīng)有差異。治療結(jié)束后3個(gè)月漢族患者特異性T細(xì)胞反應(yīng)明顯恢復(fù)。回顧分析181例鼻咽癌初治患者,其中維吾爾族60例,漢族121例,全組患者5年OS、DFS、LC、RC、DMFS分別為:80.2%、67.9%、87.9%、94.9%、77.6%,維吾爾族和漢族患者之間無差異。維吾爾族患者OS的影響因素為:年齡;DFS的影響因素為:年齡、N分期;漢族患者OS的影響因素為:年齡、N分期;DFS的影響因素為:年齡。維吾爾族患者放射治療引起的皮膚、粘膜反應(yīng)輕于漢族患者。結(jié)論:新疆維吾爾族和漢族鼻咽癌患者在遺傳、T細(xì)胞免疫、預(yù)后影響因素方面存在差異。
[Abstract]:Objective: to analyze the difference of HLA allele polymorphism, LMP2A specific T cell immune response, prognosis and influencing factors in patients with nasopharyngeal carcinoma (NPC) in Xinjiang Uygur and Han nationality. Methods: the peripheral blood samples of nasopharyngeal carcinoma patients from January 2011 to December 2014 in Xinjiang Cancer Hospital were collected and HLA alleles were detected by DNA,PCR-SSP method. Peripheral blood mononuclear cells (PBMC) were isolated and LMP2A specific T cell immunoreaction was detected by ELISPOT method before and 3 months after treatment. Clinical data of 181 patients with nasopharyngeal carcinoma treated with IMRT were analyzed retrospectively and the prognosis and its influencing factors were analyzed. Results: the distribution and frequency of HLA allele in Xinjiang Uygur and Han nationality patients were different. The frequency of HLA-B46,C06,DQB107,DRB102 allele in Uygur nasopharyngeal carcinoma patients was higher than that in Han nationality patients (P0.05). The frequency of HLA-A02,A03,C01,DQB108,DQB109 allele in patients with nasopharyngeal carcinoma of Uygur nationality was lower than that in Han nationality (P0.05), and the susceptible base of nasopharyngeal carcinoma in Uygur nationality was HLA-C14 (P0. 041). The susceptibility gene of nasopharyngeal carcinoma in Han nationality is: HLA-A02,B46,C01; protection gene: HLA-A30,B13. The immune response of LMP2A specific T cells in the newly treated patients was significantly lower than that in the healthy controls. The specific T cell response of Uygur patients at different age and T stage group was different, while that of Han nationality patients was different at different N stages. The specific T cell response of HLA-A02 allele carrying group was different. The specific T cell response of Han nationality patients recovered significantly 3 months after treatment. A retrospective analysis of 181 patients with nasopharyngeal carcinoma (NPC), including 60 cases of Uygur nationality and 121 cases of Han nationality, was made. The OS,DFS,LC,RC,DMFS in the whole group for 5 years was 80.2 and 67.9, respectively. There was no difference between Uygur and Han patients. The influencing factors of OS in Uygur patients were age; the influencing factors of DFS were age and N stage; the influencing factors of OS in Han nationality were age, N stage; the influencing factors of DFS were age. The mucosal reaction of Uygur patients after radiotherapy is lighter than that of Han patients. Conclusion: there are differences in heredity, T cell immunity and prognostic factors between Xinjiang Uygur and Han nationality patients with nasopharyngeal carcinoma.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R739.63

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