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目的评价分化型甲状腺癌~(131)I治疗后外周血B细胞(CD19)、T细胞(CD3)、NK细胞和CD_4~+、CD_8~+亚群的变化。方法分化型甲状腺癌患者102例,分为A(8例)、B(43例)、C(51例)3组。A组为甲状腺癌术后首次用~(131)I清除残余甲状腺者,用50mCi~(131)I治疗。B组为颈部淋巴结转移者,用100mCi~(131)I治疗。C组为远端转移者,用200mCi~(131)I治疗。分别于患者口服~(131)I治疗前1天和治疗后第7天、1个月、3个月取外周血,用流式细胞仪检测外周血B细胞、T细胞、NK细胞,CD_4~+、CD_8~+亚群的百分比。同时检测10名正常人的外周血淋巴细胞亚群水平,作为正常对照组。结果A组中,仅治疗后7d NK细胞(P<0.05)和B细胞(P<0.05)百分比显著降低。B组中,治疗后7d(P<0.01)和1个月(P<0.05)NK细胞百分比显著下降,而B细胞百分比仅在治疗后7d显著下降(P<0.05);对于T细胞,仅治疗后1个月CD_4~+/CD_8~+的比值下降(P<0.05)。C组中,NK细胞和B细胞百分比在治疗后7d(P<0.05)和1个月(P<0.05)均显著下降;治疗后1个月,CD_4~+/CD_8~+的比值显著下降(P<0.05)。~(131)I治疗后3个月,3组中所有患者外周血淋巴细胞亚群百分比与治疗前相比,均无显著变化。结论分化型甲状腺癌~(131)I治疗时,外周血淋巴细胞对~(131)I内照射的辐射敏感性主要取决于淋巴细胞的类型和~(131)I的剂量。NK细胞和B细胞对~(131)I的辐射可能最为敏感。大剂量~(131)I治疗时,B细胞、T细胞、NK细胞,CD_4、CD_8亚群都将受到不同程度的影响,但这种影响是可恢复的。因此,~(131)I内照射治疗的免疫抑制作用是暂时的和可逆的。
Objective To evaluate the changes of peripheral blood B cells (CD19), T cells (CD3), NK cells and CD_4 ~ + CD_8 ~ + subsets in patients with differentiated thyroid carcinoma after 131I treatment. Methods 102 patients with differentiated thyroid cancer were divided into A (8 cases), B (43 cases) and C (51 cases). Group A was the first thyroid cancer with 131I removal of residual thyroid gland, followed by treatment with 50mCi ~ (131) I. B group for cervical lymph node metastasis, with 100mCi ~ (131) I treatment. C group for the distal transfer, with 200mCi ~ (131) I treatment. Peripheral blood was taken from patients before oral administration of 131I for 1 day and 7 days, 1 month and 3 months after treatment. The levels of peripheral blood B cells, T cells, NK cells, CD 4 ~ +, The percentage of CD_8 ~ + subpopulation. At the same time, the peripheral blood lymphocyte subsets of 10 normal people were detected as normal control group. Results In group A, the percentage of NK cells (P <0.05) and B cells (P <0.05) decreased significantly only 7 days after treatment. In group B, the percentage of NK cells was significantly decreased at 7 days (P <0.01) and 1 month (P <0.05), while the percentage of B cells was significantly decreased only 7 days after treatment (P <0.05) The ratio of CD_4 ~ + / CD_8 ~ + in the first month decreased (P <0.05). In group C, the percentage of NK cells and B cells decreased significantly at 7d (P <0.05) and 1 month (P <0.05) after treatment, and the ratio of CD_4 + / CD_8 + P <0.05). There was no significant change in the percentage of peripheral blood lymphocyte subsets in all the patients in the three groups after ~ (131) I treatment for 3 months. Conclusion The radiation sensitivity of peripheral blood lymphocytes to ~ (131) I irradiation depends on the type of lymphocytes and the dose of ~ (131) I when differentiated thyroid cancer ~ (131) I treatment. NK cells and B cells may be the most sensitive to ~ (131) I radiation. In high dose 131I treatment, B cells, T cells, NK cells, CD 4 and CD 8 subsets will be affected to varying degrees, but this effect is recoverable. Therefore, the immunosuppressive effect of ~ (131) I irradiation is transient and reversible.