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目的:观察体外扩增的不成熟树突状细胞(dendritic cells,DC)胸腔内注射对恶性胸腔积液的疗效和安全性。方法:从6例对化疗耐药的恶性胸腔积液患者采集外周血单个核细胞,体外细胞因子诱导培养获得不成熟DC,每4周患者胸腔内注射DC(5~10)×107个,连续3次为一疗程,观察治疗后患者胸腔积液的变化及治疗的不良反应,流式细胞仪检测胸水中T细胞、NK细胞亚群。结果:总体疗效为:CR 2例,PR 1例,SD 1例,PD 2例,有效率为50%(3/6),获益率(CR+PR+SD)为66.7%。2例CR均为肾癌患者,缓解时间达26周和147周;3例肺癌患者中1例PR、1例SD及1例PD;1例恶性胸膜间皮瘤PD;治疗中无严重不良反应发生。DC治疗后6例患者胸水中的T细胞百分率均较治疗前上升,但差异无统计学意义;NK细胞百分率较治疗前明显上升(P<0.05)。结论:采用无抗原加载的自体不成熟DC胸腔内注射治疗恶性胸腔积液的疗效肯定,可能主要是通过NK细胞介导,是一种安全、有效的治疗方法。
Objective: To observe the efficacy and safety of intrapleural injection of immature dendritic cells (DCs) expanded in vitro on malignant pleural effusion. Methods: Peripheral blood mononuclear cells (PBMCs) were collected from 6 patients with chemoresistant malignant pleural effusions. Immature DCs were induced by cytokine induction in vitro. DCs (5 ~ 10) × 107 were injected into the thoracic cavity every 4 weeks. 3 times for a course of treatment to observe changes in patients after treatment of pleural effusion and adverse reactions, the detection of pleural fluid T cells, NK cell subsets. Results: The overall curative effect was CR 2 cases, PR 1 case, SD 1 case and PD 2 cases. The effective rate was 50% (3/6) and the benefit rate (CR + PR + SD) was 66.7%. 2 cases of CR were all renal cell carcinoma patients, the remission time was 26 weeks and 147 weeks; 3 cases of lung cancer patients in 1 case of PR, 1 case of SD and 1 case of PD; 1 case of malignant pleural mesothelioma PD; no serious adverse reactions in the treatment occur. The percentage of T cells in pleural effusion of 6 patients after DC treatment was higher than that before treatment, but the difference was not statistically significant. The percentage of NK cells was significantly higher than that before treatment (P <0.05). Conclusion: The therapeutic effect of intrapleural injection of immature DCs without antigen on malignant pleural effusion may be mainly mediated by NK cells, which is a safe and effective treatment.