乳腺癌患者外周血淋巴细胞亚型和血小板水平及其临床意义

doi:10.3969/j.issn.1673-8640.2017.011.014

摘要/Abstract

摘要：

目的测定乳腺癌患者外周血中淋巴细胞亚型和血小板（PLT）水平,探讨其与乳腺癌临床病理特征的关系。方法选取女性原发浸润性乳腺癌患者92例为乳腺癌组,以同期体检健康女性50名为对照组;采用血液分析仪测定PLT水平,流式细胞仪检测淋巴细胞亚型CD3⁺、CD4⁺和CD8⁺水平。结果与对照组比较,乳腺癌组外周血CD3⁺和CD4⁺明显降低,CD8⁺和PLT明显升高（P<0.01）。乳腺癌不同病理特征外周血中CD3⁺和CD8⁺比较差异无统计学意义（P>0.05）。乳腺癌不同年龄、肿瘤大小及病理类型患者间外周血中CD4⁺和PLT水平比较差异无统计学意义（P>0.05）。乳腺癌不同组织分级及淋巴结是否转移患者间外周血中CD4⁺和PLT水平比较差异有统计学意义（P<0.01）。乳腺癌外周血中CD4⁺与PLT水平呈显著负相关[等级相关系数（rs）=-0.43,P<0.01]。结论乳腺癌患者外周血中存在CD4⁺低水平和PLT高水平,二者呈显著负相关,且与乳腺癌的组织分级和淋巴结转移密切有关。

关键词: 乳腺癌, 外周血, 淋巴细胞, 血小板

Abstract:

Objective To determine the levels of lymphocyte subsets and platelet（PLT） in peripheral blood of breast cancer patients,and to investigate their correlations with clinicopathological characteristics of breast cancer. Methods A total of 92 patients with primary invasive breast cancer were enrolled,and 50 healthy subjects were enrolled as control group. PLT level was determined by hematology analyzer. The levels of lymphocyte subset CD3⁺,CD4⁺ and CD8⁺were determined by flow cytometry. Results Compared with control group,the levels of CD3⁺ and CD4⁺ were decreased,while CD8⁺ and PLT levels were increased（P<0.01）. There was no statistical significance for the levels of CD3⁺ and CD8⁺ in different clinicopathological characteristics of breast cancer（P>0.05）. The levels of CD4⁺ and PLT had no statistical significance with age,tumor size and pathological pattern（P>0.05）,but they had statistical significance with histological grade and lymph node metastasis（P<0.01）. The levels of CD4⁺ and PLT had negative correlation [coefficient of rank correlation（rs）=-0.43,P<0.01]. Conclusions Low level of CD4⁺ and high level of PLT in peripheral blood of breast cancer patients have negative correlation,which are related to histological grade and lymph node metastasis.

Key words: Breast cancer, Peripheral blood, Lymphocyte, Platelet

中图分类号:

R446.1

张静, 骆剑明. 乳腺癌患者外周血淋巴细胞亚型和血小板水平及其临床意义[J]. 检验医学, 2017, 32(11): 1004-1007.

ZHANG Jing, LUO Jianming. Levels of lymphocyte subsets and platelet in peripheral blood of breast cancer patients[J]. Laboratory Medicine, 2017, 32(11): 1004-1007.

图/表 3

参考文献 19

[1]	FAN L,STRASSER-WEIPPL K,LI J J,et al.Breast cancer in China[J]. Lancet Oncol,2014,15(7):e279-e289.
[2]	ZHANG Y,JIA H,WANG S,et al.Cumulative review and meta-analyses on the association between MTHFR rs1801133 polymorphism and breast cancer risk:a pooled analysis of 83 studies with 74 019 participants[J]. Minerva Med,2017,108(1):57-73.
[3]	DIRICAN E,AKKIPRIK M.Functional and clinical significance of SALL4 in breast cancer[J]. Tumour Biol,2016,37(9):11701-11709.
[4]	SVOBODA M,NAVRÁTIL J,SLABY O. Immunotherapy for the prevention and treatment of breast cancer[J]. Klin Onkol,2015,28(6):416-425.
[5]	TEMPLETON A J,MCNAMARA M G,ŠERUGA B,et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors:a systematic review and meta-analysis[J]. J Natl Cancer Inst,2014,106(6): dju124.
[6]	WANG C H,LI J Z,ZHANG W.Breast cancer molecular subtypes of Uygur and Han in Xinjiang of China[J]. Int J Clin Exp Med,2014,7(4):1116-1121.
[7]	沈镇宙,邵志敏. 乳腺肿瘤学[M]. 上海:上海科学技术出版社,2005:1.
[8]	徐兵河. 乳腺肿瘤2010版CNCCN乳腺癌指南更新要点解读[M]. 北京:中国协和医科大学出版社,2010:227-231.
[9]	LEE C,PARK S,KIM J H,et al.Expression of T-lymphocyte markers in human epidermal growth factor receptor 2-positive breast cancer[J]. J Breast Cancer,2016,19(4):385-393.
[10]	CHEN L Y,TSANG J Y,NI Y B,et al.Lymphocyte subsets contribute to the degree of lobulitis and ductitis in sclerosing lymphocytic lobulitis of the breast[J]. J Clin Pathol,2016,69(6):527-532.
[11]	韦常宏,宁淑芳,韦文娥,等. 乳腺癌淋巴细胞亚群与不同分子亚型及临床病理特征的意义研究[J]. 中国当代医药,2016,23(11):8-11.
[12]	ILHAN-MUTU A,STARLINGER P,PERKMANN T,et al.Plasma fibrinogen and blood platelet counts are associated with response to neoadjuvant therapy in esophageal cancer[J]. Biomark Med,2015,9(4):327-335.
[13]	SHIAO J,THOMAS K M,RAHIMI A S,et al.Aspirin/antiplatelet agent use improves disease-free survival and reduces the risk of distant metastases in Stage Ⅱ and Ⅲ triple-negative breast cancer patients[J]. Breast Cancer Res Treat,2017,161(3):463-471.
[14]	AOE K,HIRAKI A,UEOKA H,et a1. Thrombocytosis as a useful prognostic indicator in patients with lung cancer[J]. Respiration,2004,71(2):170-173.
[15]	KEDZIERSKA M,CZERNEK U,SZYDLOWSKA-PAZERA K,et al.The changes of blood platelet activation in breast cancer patients before surgery,after surgery,and in various phases of the chemotherapy[J]. Platelets,2013,24(6):462-468.
[16]	徐立风,刘涤暇,董凤珍. 乳腺癌与血小板增多关系探讨[J]. 中国误诊学杂志,2007,7(13):3023.
[17]	彭松. 血小板-淋巴细胞相互作用与动脉粥样硬化[J]. 中国动脉硬化杂志,2014,22(8):853-858.
[18]	KABASHIMA K,MURATA T,TANAKA H,et al.Thromboxane A2 modulates interaction of dendritic cells and T cells and regulates acquired immunity[J]. Nat Immunol,2003,4(7):694-701.
[19]	LIU C Y,BATTAGLIA M,LEE S H,et al.Platelet factor 4 differentially modulates CD4+CD25+(regulatory) versus CD4+CD25-(nonregulatory) T cells[J]. J Immunol,2005,174(5):2680-2686.

组别	例数	CD3⁺（%）	CD4⁺（%）	CD8⁺（%）	PLT（×10⁹/L）
对照组	50	66.03±6.88	32.85±3.51	22.51±2.56	117.45±15.06
乳腺癌组	92	55.27±7.86^*	23.91±5.72^*	31.49±5.53^*	251.34±50.81^*

组别	例数	CD3⁺（%）	CD4⁺（%）	CD8⁺（%）	PLT（×10⁹/L）
对照组	50	66.03±6.88	32.85±3.51	22.51±2.56	117.45±15.06
乳腺癌组	92	55.27±7.86^*	23.91±5.72^*	31.49±5.53^*	251.34±50.81^*

因素	例数	CD3⁺	CD4⁺	CD8⁺
年龄（岁）
≥55	48	54.66±9.12	23.79±8.70	31.13±11.09
<55	44	55.88±9.39	24.03±8.41	31.85±9.62
肿瘤大小（cm）
<2	50	55.95±9.05	24.21±8.08	31.05±10.21
≥2	42	54.59±9.17	23.61±8.13	31.93±9.55
病理类型
导管癌	71	54.53±9.89	24.49±9.06	30.95±11.20
小叶癌	21	56.01±9.97	23.33±9.19	32.03±9.75
组织学分级
Ⅰ~Ⅱ	69	54.40±10.73	27.38±5.13	30.67±11.83
Ⅲ	23	56.14±11.78	20.44±5.82	32.31±10.96
淋巴结转移
无	57	54.60±10.52	27.76±4.59	30.81±11.06
有	35	55.94±10.76	20.06±4.41	32.17±10.88

因素	例数	CD3⁺	CD4⁺	CD8⁺
年龄（岁）
≥55	48	54.66±9.12	23.79±8.70	31.13±11.09
<55	44	55.88±9.39	24.03±8.41	31.85±9.62
肿瘤大小（cm）
<2	50	55.95±9.05	24.21±8.08	31.05±10.21
≥2	42	54.59±9.17	23.61±8.13	31.93±9.55
病理类型
导管癌	71	54.53±9.89	24.49±9.06	30.95±11.20
小叶癌	21	56.01±9.97	23.33±9.19	32.03±9.75
组织学分级
Ⅰ~Ⅱ	69	54.40±10.73	27.38±5.13	30.67±11.83
Ⅲ	23	56.14±11.78	20.44±5.82	32.31±10.96
淋巴结转移
无	57	54.60±10.52	27.76±4.59	30.81±11.06
有	35	55.94±10.76	20.06±4.41	32.17±10.88

因素	例数	PLT	P值
年龄（岁）
≥55	48	252.16±66.05	>0.05
<55	44	250.52±68.92
肿瘤大小（cm）
<2	50	252.29±69.77	>0.05
≥2	42	250.09±59.31
病理类型
导管癌	71	250.07±68.90	>0.05
小叶癌	21	252.61±67.95
组织学分级
Ⅰ~Ⅱ	69	221.23±40.63	<0.01
Ⅲ	23	281.45±45.06
淋巴结转移
无	57	217.66±41.31	<0.01
有	35	285.02±44.75