胰腺癌患者手术前后外周血淋巴细胞亚群和血小板变化

doi:10.3969/j.issn.1673-8640.2020.07.006

摘要/Abstract

摘要：

目的测定胰腺癌患者手术前后外周血淋巴细胞亚群和血小板（PLT）水平,并探讨其与胰腺癌患者临床病理参数的相关性。方法选取66例胰腺癌患者（胰腺癌组）,以64名体检健康者作为对照组。检测所有对象淋巴细胞亚群[CD3⁺T细胞、CD3⁺CD4⁺T细胞、CD3⁺CD8⁺T细胞、B细胞和自然杀伤（NK）细胞]及PLT水平,分析其与胰腺癌临床病理参数的相关性。结果与对照组相比,胰腺癌组术前外周血CD3⁺T细胞和CD3⁺CD4⁺T细胞水平明显降低（P<0.05）,CD3⁺CD8⁺T细胞和PLT水平明显升高（P<0.05）;胰腺癌组术后CD3⁺T细胞和CD3⁺CD4⁺T细胞水平较术前明显升高（P<0.05）,PLT较术前明显降低（P<0.05）;胰腺癌组术后与对照组之间CD3⁺T细胞、CD3⁺CD4⁺T细胞、CD3⁺CD8⁺T细胞、B细胞、NK细胞和PLT水平差异均无统计学意义（P>0.05）;胰腺癌组术前外周血CD3⁺T细胞、CD3⁺CD4⁺T细胞、CD3⁺CD8⁺T细胞、B细胞、NK细胞、PLT水平与患者年龄、肿瘤大小、肿瘤部位、有无神经浸润、分化程度无关（P>0.05）;外周血CD3⁺CD4⁺T细胞、PLT水平与胰腺癌不同组织分级、有无淋巴结转移有关（P<0.05）。胰腺癌组术前外周血CD3⁺CD4⁺T细胞水平与PLT水平呈负相关（r=-0.44,P<0.01）。结论胰腺癌患者细胞免疫功能术前处于被抑制状态,术后可基本恢复正常。胰腺癌患者术前淋巴细胞免疫异常与PLT水平、胰腺癌组织分级和淋巴结转移相关。

关键词: 淋巴细胞, 血小板, 胰腺癌

Abstract:

Objective To determine the levels of lymphocyte subsets and platelet（PLT） in peripheral blood of preoperative and postoperative patients with pancreatic cancer,and to investigate the correlation between these indicators and clinicopathologic parameters of pancreatic cancer patients. Methods A total of 66 patients with pancreatic cancer were enrolled,and 64 healthy subjects were enrolled as control group. The expression levels of lymphocyte subsets [CD3⁺T cells,CD3⁺CD4⁺T cells,CD3⁺CD8⁺T cells,B cells and natural killer（NK） cells] and the level of PLT were determined. The correlations with clinicopathologic parameters were evaluated. Results Compared with control group,the expression levels of CD3⁺T cells and CD3⁺CD4⁺T cells were decreased in preoperative pancreatic cancer group（P<0.05）,and the expression levels of CD3⁺CD8⁺T cells and PLT were increased（P<0.05）. The expression levels of CD3⁺T cells and CD3⁺CD4⁺T cells in postoperative group were higher than those in preoperative group（P<0.05）,and the expression levels of PLT were lower than those in preoperative group（P<0.05）. There was no statistical significance in the expression levels of CD3⁺T cells,CD3⁺CD4⁺T cells,CD3⁺CD8⁺T cells,B cells,NK cells and PLT between postoperative pancreatic cancer group and control group（P>0.05）. There was no correlation between the expression levels of CD3⁺T cells,CD3⁺CD4⁺T cells,CD3⁺CD8⁺T cells,B cells,NK cells and PLT in preoperative peripheral blood and some clinicopathologic parameters（age,tumor size,tumor site,nerve infiltration and the degree of differentiation）（P>0.05）. The expression levels of CD3⁺CD4⁺T cells and PLT had correlations with different tissue grades and with or without lymph node metastasis（P<0.05）. Preoperative peripheral blood level of CD3⁺CD4⁺T cells was negatively correlated with PLT（r=-0.44,P<0.01）. Conclusions The cellular immune function of preoperative pancreatic cancer patients is inhibited,and the cellular immune function can be restored after operative treatment. Lymphocyte immunologic abnormalities are associated with PLT and are associated with tissue grading and lymph node metastasis in pancreatic cancer.

Key words: Lymphocyte, Platelet, Pancreatic cancer

中图分类号:

R446.1

程娟, 管世鹤, 陈礼文, 张敬军, 陈淑英. 胰腺癌患者手术前后外周血淋巴细胞亚群和血小板变化[J]. 检验医学, 2020, 35(7): 655-659.

CHENG Juan, GUAN Shihe, CHEN Liwen, ZHANG Jingjun, CHEN Shuying. Level changes of lymphocyte subsets and platelet in peripheral blood of preoperative and postoperative patients with pancreatic cancer[J]. Laboratory Medicine, 2020, 35(7): 655-659.

图/表 2

参考文献 16

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组别	例数	CD3⁺T细胞 /%	CD3⁺CD4⁺T细胞 /%	CD3⁺CD8⁺T细胞 /%	B细胞/%	NK细胞/%	PLT计数/ （×10⁹/L）
对照组	64	71.83±5.42	44.77±5.45	19.88±4.88	15.06±4.05	21.17±4.53	168.47±35.62
胰腺癌组
术前	66	64.06±13.69^**	35.76±10.93^**	22.67±8.25^*	14.32±7.91	20.82±12.36	204.64±62.30^**
术后	66	70.85±11.32^##	47.38±9.23^##	20.94±8.04	15.50±6.50	20.94±9.40	167.83±56.14^#

组别	例数	CD3⁺T细胞 /%	CD3⁺CD4⁺T细胞 /%	CD3⁺CD8⁺T细胞 /%	B细胞/%	NK细胞/%	PLT计数/ （×10⁹/L）
对照组	64	71.83±5.42	44.77±5.45	19.88±4.88	15.06±4.05	21.17±4.53	168.47±35.62
胰腺癌组
术前	66	64.06±13.69^**	35.76±10.93^**	22.67±8.25^*	14.32±7.91	20.82±12.36	204.64±62.30^**
术后	66	70.85±11.32^##	47.38±9.23^##	20.94±8.04	15.50±6.50	20.94±9.40	167.83±56.14^#

临床参数	例数	CD3⁺T细胞/%	CD3⁺CD4⁺T细胞/%	CD3⁺CD8⁺T细胞/%	B细胞/%	NK细胞/%	PLT计数/（×10⁹/L）
性别
男	35	63.17±13.38	34.14±9.62	23.37±9.19	13.60±5.55	23.23±13.44	208.20±61.69
女	31	65.06±14.17	37.58±12.15	21.87±7.11	15.13±9.96	18.10±10.58	206.58±63.50
年龄/岁
<60	27	67.48±13.09	35.59±9.51	24.15± 7.66	15.85 ±8.36	18.56±10.15	215.56±66.20
≥60	39	61.69±13.75	35.87 ±11.94	21.64 ±8.59	13.26 ±7.50	22.38±13.59	196.15±59.46
肿瘤大小/cm
<2	24	63.50±13.98	36.21±11.49	23.00±6.85	13.33±6.27	22.33±14.59	211.79±53.14
≥2	42	64.38±13.68	35.50±10.73	22.48±9.03	14.88±8.72	19.95±10.99	199.69±67.55
部位
胰头	44	66.02±13.80	37.41±11.12	22.98±8.01	14.14±7.87	19.11±11.07	197.27±65.18
胰体尾	22	60.14±12.86	32.45±9.98	22.05±8.88	14.68±8.16	24.23±14.29	217.73±55.84
神经浸润
有	19	59.05±11.38	34.11±10.32	21.63±7.83	16.58±9.46	24.11±12.99	206.68±60.25
无	47	66.09±14.12	36.43±11.21	23.09±8.46	13.40±7.09	19.49±11.99	203.04±64.06
分化程度
高	33	64.79±12.53	35.58±10.73	22.73±8.27	14.18±7.32	18.76±10.55	207.48±61.55
中、低	33	63.33±14.91	35.94±11.30	22.60±8.36	14.45±8.57	22.88±13.80	200.70±64.30
TNM分期
Ⅰ~Ⅱ期	45	65.19±13.62	37.82±10.93	22.51±7.61	13.88±6.82	20.69±11.76	190.76±55.44
Ⅲ~Ⅳ期	21	60.20±13.67	28.73±7.73^*	23.20±10.43	15.80±10.99	21.27±14.69	249.40±65.87^*
淋巴结转移
有	11	57.82±14.52	26.64±7.66	24.09±11.64	16.45±12.59	24.64±15.86	238.36±70.91
无	55	65.31±13.30	37.58±10.62^##	22.38±7.51	13.89±6.69	20.05±11.57	197.24±59.08^#

临床参数	例数	CD3⁺T细胞/%	CD3⁺CD4⁺T细胞/%	CD3⁺CD8⁺T细胞/%	B细胞/%	NK细胞/%	PLT计数/（×10⁹/L）
性别
男	35	63.17±13.38	34.14±9.62	23.37±9.19	13.60±5.55	23.23±13.44	208.20±61.69
女	31	65.06±14.17	37.58±12.15	21.87±7.11	15.13±9.96	18.10±10.58	206.58±63.50
年龄/岁
<60	27	67.48±13.09	35.59±9.51	24.15± 7.66	15.85 ±8.36	18.56±10.15	215.56±66.20
≥60	39	61.69±13.75	35.87 ±11.94	21.64 ±8.59	13.26 ±7.50	22.38±13.59	196.15±59.46
肿瘤大小/cm
<2	24	63.50±13.98	36.21±11.49	23.00±6.85	13.33±6.27	22.33±14.59	211.79±53.14
≥2	42	64.38±13.68	35.50±10.73	22.48±9.03	14.88±8.72	19.95±10.99	199.69±67.55
部位
胰头	44	66.02±13.80	37.41±11.12	22.98±8.01	14.14±7.87	19.11±11.07	197.27±65.18
胰体尾	22	60.14±12.86	32.45±9.98	22.05±8.88	14.68±8.16	24.23±14.29	217.73±55.84
神经浸润
有	19	59.05±11.38	34.11±10.32	21.63±7.83	16.58±9.46	24.11±12.99	206.68±60.25
无	47	66.09±14.12	36.43±11.21	23.09±8.46	13.40±7.09	19.49±11.99	203.04±64.06
分化程度
高	33	64.79±12.53	35.58±10.73	22.73±8.27	14.18±7.32	18.76±10.55	207.48±61.55
中、低	33	63.33±14.91	35.94±11.30	22.60±8.36	14.45±8.57	22.88±13.80	200.70±64.30
TNM分期
Ⅰ~Ⅱ期	45	65.19±13.62	37.82±10.93	22.51±7.61	13.88±6.82	20.69±11.76	190.76±55.44
Ⅲ~Ⅳ期	21	60.20±13.67	28.73±7.73^*	23.20±10.43	15.80±10.99	21.27±14.69	249.40±65.87^*
淋巴结转移
有	11	57.82±14.52	26.64±7.66	24.09±11.64	16.45±12.59	24.64±15.86	238.36±70.91
无	55	65.31±13.30	37.58±10.62^##	22.38±7.51	13.89±6.69	20.05±11.57	197.24±59.08^#