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目的探讨经导管动脉化疗栓塞术(TACE)中化疗药物剂量对肝细胞癌(HCC)患者T细胞亚群的影响。方法36例不能手术切除的HCC患者随机分成A、B两组,分别行选择性TACE。A组(n=18)给予小剂量化疗药物:肿瘤直径小于5 cm者给予丝裂霉素(MMC)2~4 mg;在5~8 cm之间者给予MMC 4~6 mg及表阿霉素(EPI)10 mg;大于8 cm者给予MMC 6~8 mg、EPI 10 mg及卡铂(CBP)100 mg。B组(n=18)给予常规剂量化疗药物(MMC 10 mg、CBP 300 mg及EPI 40 mg)。术前和术后1周用流式细胞仪检测患者外周血T细胞亚群(包括CD3+、CD4+、CD8+、NK、CD4+/CD8+、CD4+CD45+、CD4+CD29+、CD8+CD28+、CD8+CD28-)。结果治疗前两组间各细胞亚群均无显著差异;A组患者治疗后CD3+、CD4+、CD8+、NK、CD4+/CD8+、CD4+CD29+、CD8+CD28-无显著变化,但CD4+CD45+显著下降(P<0.05),CD8+CD28+明显增高(P<0.001);B组CD4+、CD4+CD29+和CD4+/CD8+比值显著下降(P<0.05),CD8+、CD8+CD28-显著增高(P<0.05)。结论常规剂量化疗药物TACE可明显抑制细胞免疫功能,而小剂量化疗药物TACE可以提高患者细胞免疫功能。
Objective To investigate the effect of chemotherapeutic dose on T cell subsets in patients with hepatocellular carcinoma (HCC) under transcatheter arterial chemoembolization (TACE). Methods Thirty-six patients with unresectable HCC were randomly divided into A and B groups, with selective TACE. Patients in group A (n = 18) received low-dose chemotherapy: MMC (2 to 4 mg) was given for tumors less than 5 cm in diameter; MMC (4-6 mg) and MMC (EPI) 10 mg; those over 8 cm were given 6-8 mg of MMC, 10 mg of EPI and 100 mg of carboplatin (CBP). Group B (n = 18) were given conventional chemotherapy (MMC 10 mg, CBP 300 mg and EPI 40 mg). Peripheral blood T lymphocyte subsets (including CD3 +, CD4 +, CD8 +, NK, CD4 + / CD8 +, CD4 + CD45 +, CD4 + CD29 +, CD8 + CD28 +, CD8 + CD28- ). Results There was no significant difference in the cell subpopulation between the two groups before treatment. The level of CD3 +, CD4 +, CD8 +, NK, CD4 + / CD8 +, CD4 + CD29 + and CD8 + CD28- (P <0.05). The ratio of CD4 +, CD4 + CD29 + and CD4 + / CD8 + in group B was significantly decreased (P <0.05) and CD8 +, CD8 + . Conclusion Conventional dose chemotherapy drugs TACE can significantly inhibit cellular immune function, while low-dose chemotherapy drug TACE can improve cellular immune function.