本文選題：肝細(xì)胞癌　切入點：明膠海明微粒　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:應(yīng)用明膠海綿微粒經(jīng)導(dǎo)管肝動脈化療栓塞術(shù)(GSMs-TACE)治療肝細(xì)胞癌(HCC),探討該方法對肝癌患者外周血中GPC3特異性細(xì)胞毒性T淋巴細(xì)胞(GPC3-CTLs)頻數(shù)及百分率影響和臨床意義。方法:選擇符合入組標(biāo)準(zhǔn)11例HCC患者行GSMs-TACE治療,5例HCC患者行外科手術(shù)切除治療作為對照組,9例健康人為健康對照組。所有患者在術(shù)前1天及術(shù)后4天、10天、20天常規(guī)行腫瘤標(biāo)志物(AFP、PIVKA-Ⅱ)及各種生化檢查,術(shù)后4天、30天分別行上腹部CT平掃及增強CT檢查。于術(shù)前1天、術(shù)后10、20天采集前臂外周靜脈血2m L,正常對照組采集靜脈血2ml。應(yīng)用HLA-A基因分型法、四聚體技術(shù)、流式細(xì)胞技術(shù)檢測外周血GPC3-CTLs頻數(shù)及百分率。結(jié)果:應(yīng)用流式細(xì)胞儀檢測外周血中GPC3-CTLs頻數(shù)及GPC3-CTLs百分率,與正常對照組相比,GSMs-TACE治療組GPC3-CTLs頻數(shù)及百分率明顯升高,差異有統(tǒng)計學(xué)意義(p0.05)。HCC患者行GSMs-TACE治療后10、20天外周血中GPC3-CTLs頻數(shù)和百分率變化與術(shù)前比較差異有統(tǒng)計學(xué)意義(p0.05)。并且GSMs-TACE術(shù)后10天GPC3-CTLs頻數(shù)及百分率與術(shù)前相比明顯增高,并出現(xiàn)峰值,術(shù)后20天指標(biāo)雖然下降但仍大于術(shù)前水平。外科手術(shù)對照組術(shù)前與術(shù)后10、20天外周血中GPC3-CTLs頻數(shù)和百分率變化比較差異有統(tǒng)計學(xué)意義(p0.05)。GPC3-CTLs頻數(shù)和百分率較術(shù)前逐漸下降。HCC患者ALT、AST以及TBIL指標(biāo)均在術(shù)后第4天升高,隨后逐漸下降至正常范圍,ALT、TBIL術(shù)后第10、20天與術(shù)前相比較均無統(tǒng)計學(xué)差異(p0.05),AST術(shù)后20天與術(shù)前比較無統(tǒng)計學(xué)差異(p0.05),ALB術(shù)后4天、10天、20天與術(shù)前比較差異無統(tǒng)計意義(p0.05)。AFP、PIVKA-Ⅱ術(shù)后4天、10天、20天較術(shù)前比較明顯下降,且呈進(jìn)行性下降趨勢,差異有統(tǒng)計意義p0.05)。結(jié)論:GSMs-TACE治療HCC后,促進(jìn)外周血GPC3-CTLs頻數(shù)及百分率增加,初步證實GSMs-TACE方法可以激活機體內(nèi)源性抗腫瘤特異性免疫反應(yīng);GSMs-TACE能促進(jìn)HCC患者外周血GPC3-CTLs頻數(shù)及百分率增加,與該方法造成腫瘤大范圍壞死有關(guān)。
[Abstract]:Objective: to study the effect of gelatin sponge particles transcatheter hepatic arterial chemoembolization (GSMs-TACEE) on the frequency and percentage of GPC3 specific cytotoxic T lymphocytes in peripheral blood of patients with hepatocellular carcinoma (HCC) and its clinical significance. Methods: 11 patients with HCC were treated with GSMs-TACE and 5 patients with HCC were treated with surgical resection as control group. 9 healthy persons were selected as control group. All patients were treated with GSMs-TACE before operation and 4 days after operation. All kinds of biochemical tests were performed. The peripheral venous blood of forearm was collected 1 day before operation and 1020 days after operation, and 2 ml of venous blood was collected in normal control group. HLA-A genotyping method and tetramer technique were used. Results: the frequency and percentage of GPC3-CTLs and GPC3-CTLs in peripheral blood were detected by flow cytometry. Compared with the control group, the frequency and percentage of GPC3-CTLs in GSMs-TACE treatment group were significantly increased. There was significant difference in the frequency and percentage of GPC3-CTLs in peripheral blood of patients with GSMs-TACE 10 ~ 20 days after GSMs-TACE treatment, and there was a significant difference in the frequency and percentage of GPC3-CTLs between 10 days after GSMs-TACE and 10 days after GSMs-TACE, and there was a peak value in the frequency and percentage of GPC3-CTLs at 10 days after GSMs-TACE. The frequency and percentage of GPC3-CTLs in peripheral blood of the surgical control group was significantly lower than that of the preoperative control group, and the frequency and percentage of GPC3-CTLs in the peripheral blood of the surgical control group were decreased gradually compared with those before the operation. The levels of alt and TBIL in HCC patients increased on the 4th day after operation. Then it gradually decreased to the normal range. There was no statistical difference between 10 and 20 days after operation. There was no statistical difference between 20 days after operation and 20 days after operation. There was no statistical difference between before and after operation. There was no statistical difference between before and after 4 days, 10 days and 20 days after ALB. AFPPIVKA- 鈪，

本文編號：1590508