本文關(guān)鍵詞：進(jìn)展期大腸癌患者圍手術(shù)期免疫狀態(tài)的研究　出處：《天津醫(yī)科大學(xué)》2008年碩士論文　論文類型：學(xué)位論文

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【摘要】： 目的:證實(shí)手術(shù)打擊可以造成機(jī)體免疫異常狀態(tài)。證實(shí)“瘤源性免疫抑制”的存在。探討進(jìn)展期大腸癌患者圍手術(shù)期的免疫功能狀態(tài)變化的臨床意義。探討“瘤源性免疫抑制”的可能機(jī)制,推測(cè)改善免疫抑制狀態(tài)的治療切入點(diǎn)方法:選擇10例良性病患者作為對(duì)照組(A組),年齡跨度27~71歲,中位年齡57歲:男性患者6例,女性患者4例。選取2006年于天津人民醫(yī)院肛腸外科住院的進(jìn)展期大腸癌患者10例(B組),年齡跨度53-82歲,中位年齡63歲,男性患者8例,女性患者2例,所有入組進(jìn)展期大腸癌患者均經(jīng)結(jié)腸鏡活檢病理學(xué)檢查確診。術(shù)前一般狀況良好,KARNOFSKY指數(shù)≥70�？瞻捉M(C組)選取健康人8例,年齡跨度27~45歲,中位年齡35歲;男性6例,女性2例。所有接受手術(shù)患者均為全麻麻醉,開腹手術(shù),未輸血。排除標(biāo)準(zhǔn):影像學(xué)診斷腫瘤轉(zhuǎn)移失去手術(shù)治療機(jī)會(huì)的患者;既往惡性直結(jié)腸腫瘤病史,或曾經(jīng)接受放療、化療、免疫抑制治療病史的患者;具有系統(tǒng)性紅斑狼瘡病史的患者;具有明確慢性支氣管哮喘病史的患者。檢測(cè)CD_3~+/TCRζ~+T細(xì)胞百分含量和血漿IFN-γ、IL-6、IL-10含量變化。采用分組對(duì)照方法檢測(cè)健康人(C組)與手術(shù)前A組B組患者機(jī)體免疫功能的變化。采用自身對(duì)照的方法比較A組患者手術(shù)前與術(shù)后第1,3,7天免疫功能的變化。采用分組對(duì)照方法比較A組B組手術(shù)治療前及術(shù)后第1,3,7天CD_3~+/TCRζ~+T細(xì)胞百分含量和血漿IFN-γ、IL-6、IL-10含量變化。結(jié)果:1手術(shù)前進(jìn)展期大腸癌患者CD_3~+/TCRζ~+T細(xì)胞百分含量和IL-6顯著高于良性手術(shù)組和健康人組。2手術(shù)期良性手術(shù)患者CD_3~+/TCRζ~+T細(xì)胞百分含量,IL6,10,IFN—γ呈動(dòng)態(tài)變化。良性手術(shù)對(duì)照組手術(shù)前后CD_3~+/TCRζ~+T細(xì)胞含量存在統(tǒng)計(jì)學(xué)差異,進(jìn)展期大腸癌患者手術(shù)前CD_3~+/TCRζ~+T細(xì)胞百分含量顯著高于良性手術(shù)組,3,手術(shù)后進(jìn)展期大腸癌患者CD_3~+/TCRζ~+T細(xì)胞百分含量持續(xù)降低與良性手術(shù)組存在統(tǒng)計(jì)學(xué)差異(p＜0.05)4,對(duì)照組手術(shù)后IFN—γ水平顯著升高,進(jìn)展期大腸癌術(shù)后變化不明顯,與對(duì)照組比較存在統(tǒng)計(jì)學(xué)差異。5,對(duì)照組IL-6水平出現(xiàn)一過性升高,大腸癌組趨勢(shì)變化不明顯,持續(xù)處于較高水平。6,對(duì)照組IL-10水平術(shù)后呈逐漸下降趨勢(shì),大腸癌組術(shù)后明顯上升與對(duì)照組相比存在統(tǒng)計(jì)學(xué)差異。結(jié)論:1、腫瘤患者體內(nèi)存在免疫狀態(tài)異常,機(jī)體動(dòng)用了可能的條件,使機(jī)體處于相對(duì)穩(wěn)定的狀態(tài),以限制腫瘤的生長(zhǎng)。2、手術(shù)創(chuàng)傷可以造成機(jī)體免疫狀態(tài)變化。3、腫瘤患者手術(shù)后,手術(shù)因素打破了機(jī)體的病態(tài)平衡狀態(tài),與瘤源性免疫抑制同時(shí)存在相互疊加,機(jī)體平衡迅速向有利于腫瘤生長(zhǎng)的方向發(fā)展,為潛在的瘤細(xì)胞在術(shù)后擴(kuò)散和復(fù)發(fā)提供可能。尋找有效手段阻斷或減輕手術(shù)因素和瘤源性免疫抑制對(duì)機(jī)體的影響,對(duì)術(shù)后腫瘤復(fù)發(fā)和轉(zhuǎn)移有一定的預(yù)測(cè)和控制作用。
[Abstract]:Objective: to prove that surgical attack can cause abnormal immune state of the body. To confirm the existence of tumor-derived immunosuppression. To explore the clinical significance of the changes of immune function in patients with advanced colorectal cancer during perioperative period. " The possible mechanism of tumor-derived immunosuppression. Methods: 10 patients with benign venereal diseases were selected as control group A, the age span was 2771 years old, median age was 57 years old: 6 cases of male patients. In 2006, 10 patients with advanced colorectal cancer in Tianjin people's Hospital were selected. The age ranged from 53 to 82 years old, with a median age of 63 years, and 8 male patients. Two female patients, all patients with advanced colorectal cancer were confirmed by colonoscopy biopsy pathological examination, preoperative general condition is good. KARNOFSKY index 鈮，

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