肝细胞肝癌复发前后CD3高表达T淋巴细胞的变化

doi:10.3969/j.issn.1673-8640.2020.03.005

摘要/Abstract

摘要：

目的探讨肝细胞肝癌（HCC）复发前后CD3高表达（CD3^bright）T细胞的变化特点。方法选取有完整住院病历资料的HCC患者69例（17例5年内未复发,52例复发）,采用流式细胞术检测其外周血CD3⁺T细胞、CD4⁺T细胞、CD8⁺T细胞及CD3^bright T细胞占总T细胞的百分比（CD3%、CD4%、CD8%、CD3^bright%）,计算CD4/CD8比值,同时检测甲胎蛋白（AFP）。采用Pearson相关分析评估CD3^bright%与其他指标的相关性。采用Logistic回归分析评估各项指标对HCC复发的提示作用。采用受试者工作特征（ROC）曲线评价各项指标判断HCC复发的价值。结果复发组AFP、CD4%、CD8%高于未复发组（P<0.01）,CD3^bright%低于未复发组（P<0.01）。CD3%和CD4/CD8比值2个组之间差异无统计学意义（P>0.05）。与术后比较,HCC患者复发后血清AFP水平明显升高（P<0.01）、CD3^bright%降低（P=0.04）,其他指标2个组之间差异均无统计学意义（P>0.05）。AFP、CD3^bright%与HCC复发独立相关[比值比（OR）分别为1.012、0.841,95%可信区间（CI）分别为1.001~1.023、0.783~0.902 ]。结论较低的CD3^bright T细胞水平与HCC较差的预后及较高的复发率有关。

关键词: CD3高表达T淋巴细胞, CD4, CD8, 甲胎蛋白, 肝细胞肝癌, 复发

Abstract:

Objective To investigate the changes of CD3^bright T lymphocytes in patients with hepatocellular carcinoma（HCC） before and after recurrence. Methods A total of 69 patients with HCC,including 52 cases of recurrence within 5 years and 17 cases without recurrence,were enrolled. By flow cytometry,the proportions of CD3⁺T cells,CD4⁺T cells,CD8⁺T cells and CD3^bright T cells in total T cells（CD3%,CD4%,CD8% and CD3^bright%） were determined,and the CD4/CD8 ratio was calculated. Alpha-fetoprotein（AFP） was determined as well. Pearson correlation analysis was used to evaluate the correlation of CD3^bright% with other indicators. Logistic regression analysis was used to evaluate the indicators for the prediction of HCC recurrence. By receiver operating characteristic（ROC） curve analysis,the roles of the indicators for the judgment of HCC recurrence were evaluated. Results The levels of AFP,CD4% and CD8% were higher（P<0.01）,and CD3^bright% was lower in patients with recurrence within 5 years than those without recurrence（P<0.01）. There was no statistical significance for CD3% and CD4/CD8 ratio between the 2 groups（P>0.05）. The level of AFP after recurrence was higher than that after operation（P<0.01）,CD3^bright% was decreased after recurrence（P=0.04）,and there was no statistical significance for the other indicators（P>0.05）. AFP and CD3^bright% were related with HCC recurrence independently [odds ratios（OR） were 1.012 and 0.841,95% confidence intervals（CI） were 1.001-1.023 and 0.783-0.902 ]. Conclusions Decreased CD3^brightT lymphocyte is related with poor prognosis and high recurrence rate.

Key words: CD3^bright T lymphocyte, CD4, CD8, Alpha-fetoprotein, Hepatocellular carcinoma, Recurrence

中图分类号:

R446.1

金方方, 金子铮, 刘宁, 娄金丽. 肝细胞肝癌复发前后CD3高表达T淋巴细胞的变化[J]. 检验医学, 2020, 35(3): 209-213.

JIN Fangfang, JIN Zizheng, LIU Ning, LOU Jinli. Changes of CD3^bright T lymphocytes in patients with hepatocellular carcinoma before and after recurrence[J]. Laboratory Medicine, 2020, 35(3): 209-213.

图/表 4

参考文献 16

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组别	例数	AFP/（ng/mL）	CD3^bright%/%	CD3%/%	CD4%/%	CD8%/%	CD4/CD8比值
复发组	52	3.55（2.15~10.32）	2.46（1.67~3.36）	69.28（61.44~75.75）	35.93（30.83~42.22）	26.65（21.65~31.51）	1.39（1.03~1.76）
未复发组	17	2.46（1.73~3.68）	6.50（3.58~10.23）	65.76（57.06~72.16）	31.60（27.98~34.82）	24.40（16.61~29.84）	1.33（1.33~1.84）
U值		2 346.50	854.50	2 794.50	2 311.00	2 573.50	3 236.00
P值		<0.01	<0.01	0.06	<0.01	<0.01	0.88

组别	例数	AFP/（ng/mL）	CD3^bright%/%	CD3%/%	CD4%/%	CD8%/%	CD4/CD8比值
复发组	52	3.55（2.15~10.32）	2.46（1.67~3.36）	69.28（61.44~75.75）	35.93（30.83~42.22）	26.65（21.65~31.51）	1.39（1.03~1.76）
未复发组	17	2.46（1.73~3.68）	6.50（3.58~10.23）	65.76（57.06~72.16）	31.60（27.98~34.82）	24.40（16.61~29.84）	1.33（1.33~1.84）
U值		2 346.50	854.50	2 794.50	2 311.00	2 573.50	3 236.00
P值		<0.01	<0.01	0.06	<0.01	<0.01	0.88

项目	例数	AFP/（ng/mL）	CD3^bright%/%	CD3%/%	CD4%/%	CD8%/%	CD4/CD8比值
术后	52	3.27（2.04~5.69）	2.67（2.07~3.32）	68.43（60.80~75.78）	34.35（30.00~38.70）	27.39（22.06~35.61）	1.39（0.95~1.73）
复发时	17	16.85 （4.40~22.60）	1.93（1.33~3.47）	69.77（62.03~75.86）	37.62（33.57~43.44）	27.75（20.52~30.99）	1.59（1.25~1.92）
U值		886.50	901.00	1 173.00	917.00	935.50	861.00
P值		0.03	0.04	0.87	0.05	0.07	0.06

项目	例数	AFP/（ng/mL）	CD3^bright%/%	CD3%/%	CD4%/%	CD8%/%	CD4/CD8比值
术后	52	3.27（2.04~5.69）	2.67（2.07~3.32）	68.43（60.80~75.78）	34.35（30.00~38.70）	27.39（22.06~35.61）	1.39（0.95~1.73）
复发时	17	16.85 （4.40~22.60）	1.93（1.33~3.47）	69.77（62.03~75.86）	37.62（33.57~43.44）	27.75（20.52~30.99）	1.59（1.25~1.92）
U值		886.50	901.00	1 173.00	917.00	935.50	861.00
P值		0.03	0.04	0.87	0.05	0.07	0.06

项目	单变量		多变量
项目	OR值（95%CI）	P值	OR值（95%CI）	P值
AFP	1.012（1.001~1.023）	0.03	1.012（1.001~1.023）	0.03
CD3^bright%	0.841（0.785~0.900）	<0.01	0.841（0.783~0.902）	<0.01
CD3%	1.033（1.006~1.060）	0.02	1.029（0.996~1.063）	0.09
CD4%	1.030（1.002~1.059）	0.12
CD8%	1.048（1.016~1.081）	<0.01	1.032（0.994~1.072）	0.1
CD4/CD8比值	0.805（0.605~1.071）	0.14