原发性肝癌根治术后恶性胸腹水患者T淋巴细胞及NK细胞水平观察

摘要/Abstract

摘要： 目的观察原发性肝癌根治术后恶性胸腹水患者T淋巴细胞及自然杀伤(NK)细胞水平。方法 2019年3月—2022年3月陕西省榆林市第二医院收治的100例原发性肝癌根治术后胸腹水患者,根据胸腹水良恶性将患者分为恶性组(24例)和非恶性组(76例)。检测胸腹水T淋巴细胞和NK细胞,以受试者工作特征曲线(ROC)分析CD3⁺、CD3⁺CD4⁺、CD3⁺CD8⁺、NK细胞水平诊断恶性胸腹水的价值,以Spearman等级相关系数分析CD3⁺、CD3⁺CD4⁺、CD3⁺CD8⁺、NK细胞水平与恶性胸腹水发生风险的的相关性。结果恶性组CD3⁺、CD3⁺CD4⁺、NK细胞水平分别为(61.2±11.3)%、(67.2±13.1)%、(20.4±3.4)%,显著低于非恶性组[分别为(75.3±9.9)%、(73.6±8.5)%、(24.5±3.6)%,P<0.05],恶性组CD3⁺CD8⁺细胞水平为(33.2±5.5)%,显著高于非恶性组[(26.3±6.1)%,P<0.05];经ROC分析,CD3⁺、CD3⁺CD4⁺、CD3⁺CD8⁺、NK细胞水平诊断恶性胸腹水的曲线下面积及95%CI分别为0.874(0.814～0.925)、0.653(0.549～0.767)、0.843(0.780～0.905)、0.846(0.786～0.910)(P<0.05);原发性肝癌根治术后恶性胸腹水风险与CD3⁺、CD3⁺CD4⁺、NK细胞水平成负相关(r=-0.625、r=-0.517、r=-0.573,P<0.05),与CD3⁺CD8⁺水平呈正相关(r=0.582,P<0.05)。结论原发性肝癌根治术后恶性胸腹水患者较非恶性胸腹水患者存在更严重的免疫功能紊乱情况,体现为CD3⁺、CD3⁺CD4⁺、NK细胞比例的下调和CD3⁺CD8⁺细胞的上调,临床可通过检测胸腹水T淋巴细胞亚群和NK细胞水平对恶性胸腹水高风险患者进行筛查。

关键词: 原发性肝癌, 肝癌根治术, 恶性胸腹水, T淋巴细胞, 自然杀伤细胞

Abstract: Objective To observe the levels of T lymphocytes and natural killer (NK) cells in patients with malignant pleural effusion after radical resection of primary liver cancer.Methods From March 2019 to March 2022, one hundred primary liver cancer patients with pleural effusion and ascites after radical resection who were admitted to the Second Hospital of Yulin City, Shaanxi Province were divided into a malignant group (n=24 cases) and a non-malignant group (n=76 cases) according to the nature of pleural effusion and ascites (i.e., malignant or benign). The levels of T lymphocytes and NK cells in pleural and ascites were detected. Receiver operating characteristic curve (ROC) was used to analyze the value of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺ and NK cell levels in the diagnosis of malignant pleural effusion. Spearman rank correlation coefficient was used to analyze the correlation between CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺ and NK cell levels and the risk of malignant pleural effusion.Results The levels of CD3⁺, CD3⁺CD4⁺ and NK cells in the malignant group were (61.2±11.3)%, (67.2±13.1)% and (20.4±3.4)%, respectively, which were significantly lower than those of (75.3±9.9)%, (73.6±8.5)%, and (24.5±3.6)% in the non-malignant group (P<0.05). The level of CD3⁺CD8⁺ cells in the malignant group was (33.2±5.5)%, which was significantly higher than that of (26.3±6.1)% in the non-malignant group (P<0.05). According to ROC analysis, the area under the curve (AUC) and 95%CI of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺ and NK cells in the diagnosis of malignant pleural effusion were 0.874 (0.814~0.925), 0.653 (0.549~0.767), 0.843 (0.780~0.905) and 0.846 (0.786~0.910), respectively (P<0.05). The risk of malignant pleural effusion after radical resection of primary liver cancer was negatively correlated with the levels of CD3⁺, CD3⁺CD4⁺ and NK cells (r=-0.625, r=-0.517, r=-0.573, P<0.05), and positively correlated with the levels of CD3⁺CD8⁺ (r=0.582, P<0.05).Conclusion Patients with malignant pleural effusion after radical resection have more serious immune dysfunction than patients with non-malignant pleural effusion, which is mainly manifested by the decrease of the proportion of CD3⁺, CD3⁺CD4⁺ and NK cells and the increase of CD3⁺CD8⁺ cells. Clinical screening of patients with high risk of malignant pleural effusion can be performed by detecting T lymphocyte subsets and NK cell levels in pleural effusion.

Key words: Primary liver cancer, Radical resection of liver cancer, Malignant hydrothorax and ascites, T lymphocytes, Natural killer cells

李姣姣, 赵永昌, 武军霞. 原发性肝癌根治术后恶性胸腹水患者T淋巴细胞及NK细胞水平观察[J]. 肝脏, 2023, 28(8): 924-927.

LI Jiao-jiao, ZHAO Yong-chang, WU Jun-xia. The T lymphocyte and NK cell levels in patients with malignant pleural effusion after radical resection of primary hepatocellular carcinoma[J]. Chinese Hepatolgy, 2023, 28(8): 924-927.

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