本文選題：立體定向體部放射治療　切入點：非小細胞肺癌　出處：《鄭州大學》2017年碩士論文

【摘要】：目的本研究采用流式細胞術的方法,前瞻地研究接受SBRT早期及寡轉移肺癌患者治療前后外周血淋巴細胞亞群比例的變化,探討SBRT對早期非小細胞肺癌及寡轉移肺癌患者免疫功能的影響。材料與方法2015年10月至2017年1月,采集在河南省腫瘤醫(yī)院放療科接受SBRT的早期非小細胞肺癌及寡轉移肺癌22例患者,其中男18例,女4例;中位年齡74歲(48-84歲)。I期肺癌14例,寡轉移8例。放療前0-7天,放療后0-7天,放療后4周分別采集外周血(可與入組常規(guī)采血一同進行),采用流式細胞術進行淋巴細胞亞群檢測:CD3+(總T細胞,Total T lymphocytes),CD3+CD4+(T輔助/誘導細胞),CD3+CD8+(T抑制/細胞毒性細胞),CD4+CD25+(調節(jié)性T細胞,Regulatory T lymphocytes,Treg),CD8+CD28-(抑制性T細胞,Suppressive T lymphocytes,Ts),CD8+CD28+(細胞毒性T細胞,Cytotoxic T lymphocytes,Tc),CD4+/CD8+(CD4+與CD8+亞群比值)。采用SPSS22.0軟件進行統(tǒng)計學分析,分類變量由頻數(shù)和百分比描述。連續(xù)變量由平均數(shù)±標準差描述。采用配對t檢驗對比治療前后自身淋巴細胞亞群比例的變化。P0.05為具有統(tǒng)計學差異。結果1.入組22例患者均放療前0-7天及放療后0-7天均進行了淋巴細胞亞群檢測,其中11例患者放療后4周進行淋巴細胞亞群檢測;2.22例患者放療前0-7天與放療后0-7天比,除CD3+放療后較放療前增加(P=0.023),其他淋巴細胞亞群比例變化不明顯(P0.05);3.11例患者放療后4周進行淋巴細胞亞群檢測,患者淋巴細胞亞群與放療之前淋巴細胞亞群比變化不明顯(P0.05),見表8;4.對于13例早期原發(fā)非小細胞肺癌患者,放療前0-7天與放療后0-7天比,各淋巴細胞亞群變化均不明顯(P0.05);5.對于9例肺部寡轉移患者,放療前0-7天與放療后0-7天比,CD3+放療后較放療前增加(P=0.027),CD3+CD4+放療后較放療前增加(P=0.038),CD4+CD25+放療后較放療前增加(P=0.032),其他淋巴細胞亞群比例變化不明顯(P0.05)。結論SBRT治療對于肺部腫瘤患者免疫功能影響不大,可以認為對于因高齡或合并嚴重心、肺等內科疾病不能或不愿接受手術的患者其是一種安全有效的治療手段。對于肺部寡轉移的患者,對其進行SBRT治療后,可能會引起免疫功能改變,可能與局部免疫反應有關。另外,SBRT治療可能引起腫瘤局部免疫反應,具體的檢測生物學標記、檢測方法以及檢測時機有待進一步研究。
[Abstract]:Objective to study the changes of lymphocyte subsets in peripheral blood of patients with early SBRT and oligometastasis lung cancer before and after treatment with flow cytometry. To investigate the effect of SBRT on immune function in patients with early non-small cell lung cancer and oligometastasis lung cancer. Materials and methods from October 2015 to January 2017, Twenty-two patients with early non-small cell lung cancer (NSCLC) and oligometastasis lung cancer (18 males and 4 females) received SBRT in radiotherapy Department of Henan Cancer Hospital, 14 patients with stage I lung cancer aged from 74 to 84 years old and 8 patients with oligometastases were enrolled. 0-7 days after radiotherapy, Four weeks after radiotherapy, peripheral blood was collected separately (which can be taken together with routine blood collection). The lymphocyte subsets were detected by flow cytometry. Total T lymphocytes were detected by total T lymphocyte lymphocyte subsets. CD3 CD8 T suppression / cytotoxicity was detected by T assisted / induced cells. The ratio of CD4 / CD8 CD25 (cytotoxic T lymphocytes) to CD _ 4 / CD _ 8 (CD _ 4 / CD _ 8 / CD8) subsets were analyzed by SPSS22.0 software, and the ratio of CD _ 4 / CD _ 8 / CD _ 8 / CD _ 8 / CD _ 8 / CD _ 8 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 / CD _ 4 / CD _ 8 subsets were analyzed by SPSS22.0 software. The classification variable is described by frequency and percentage. The continuous variable is described by mean 鹵standard deviation. The ratio of autologous lymphocyte subsets before and after treatment is compared by paired t test. Results 1. Lymphocyte subsets were detected 0-7 days before radiotherapy and 0-7 days after radiotherapy in 22 patients. Lymphocyte subsets were detected in 11 patients at 4 weeks after radiotherapy compared with 0-7 days before radiotherapy and 0-7 days after radiotherapy in 2.22 patients. The lymphocyte subsets were detected 4 weeks after radiotherapy in 3. 11 patients with CD3, except for the increase of P0. 023 after radiotherapy. The ratio of lymphocyte subsets to lymphocyte subsets before radiotherapy in 13 patients with early non-small cell lung cancer (NSCLC) was not significantly different from that before radiotherapy (P 0.05), as shown in Table 8 (4). For 13 patients with early non-small cell lung cancer (NSCLC), the ratio of 0 to 7 days before radiotherapy was higher than that of 0 to 7 days after radiotherapy. The changes of lymphocyte subsets were not significant in 9 patients with pulmonary oligometastasis. 0 to 7 days before radiotherapy and 0 to 7 days after radiotherapy, there was an increase in P0. 027 CD4 after radiotherapy and 0-7 days after radiotherapy compared with that before radiotherapy. After radiotherapy, there was an increase of P0. 032, P0. 032, and the proportion of other lymphocyte subsets in lung after radiotherapy. Conclusion SBRT treatment has no significant effect on pulmonary lung. The immune function of tumor patients was not affected. It can be considered as a safe and effective treatment for patients who are unable or unwilling to undergo surgery because of advanced age or severe heart disease. For patients with pulmonary oligometastasis, after SBRT treatment, In addition, SBRT treatment may cause local immune response of tumor. The specific detection of biological markers, detection methods and detection timing need to be further studied.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R734.2;R730.55

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