论文标题:不同剂量卡介苗灌注治疗膀胱癌患者外周血T细胞亚群的临床观察
Clinical Investigation of Peripheral Blood T Lymphcyte Subsets in Different Dose of BCG Intracavitary Instillation Treated Patients with Transitional Cell Carcinoma
论文作者 刘俊江
论文导师 霍红旭,论文学位 硕士,论文专业 外科学
论文单位 河北医科大学,点击次数 72,论文页数 47页File Size1241k
2002-03-01论文网 http://www.lw23.com/lunwen_798488637/ 卡介苗;膀胱移行细胞癌;T淋巴细胞亚群;副作用
BCG,T lymphocyte subsets,transitional cell carcinoma,side effects
目的：膀胱移行细胞癌是泌尿系统最常见的恶性肿瘤，并且在首次手术治疗后也有很高的复发倾向。卡介苗作为一种有效的生物免疫修饰剂，在预防肿瘤进展及复发方面都取得了很好效果。尽管卡介苗的作用机制并不是十分清楚，但是有很多研究都证实它能提高机体局部和全身免疫状态。本实验就是对卡介苗灌注治疗前后患者外周血中T淋巴细胞亚群的定量分析，来了解不同剂量卡介苗对患者全身免疫状态的影响以及所引起副作用和T细胞亚群变化的预测价值。 材料和方法：对我院在研究期间所收住63例膀胱移行细胞癌患者进行随机分组，分别灌注卡介苗60mg、120mg两种不同剂量。每周一次，连续六周为一个疗程。在疗程前后24小时内抽取外周静脉血行流式细胞学进行定量分析。 结果：我们的结果提示，在60mg和120mg两种不同剂量卡介苗进行灌注治疗的患者中，灌注前后外周血T淋巴细胞亚群均有改变。同一剂量卡介苗灌注治疗前后相比，灌注后CD4比灌注前有所升高，P＜0.05，具有统计学意义。灌注后CD8和灌注前相比有所降低，P＜0.05，具有统计学意义。但是在60mg和120mg两组之间相同指标变化的比较，没有明显差异，P＞0.05。在小剂量卡 中文摘要 介苗灌注治疗患者中，副作用远远少于大剂量组。 结论：卡介苗灌注治疗膀脐移行细胞癌患者可以引 起全身免疫状态的变化。不同剂量卡介苗所引起全身免 疫状态改变的程度是一致的。卡介苗灌注治疗可以引起 CD4升高和 CDS的降低。小剂量卡介苗引起的副作用较 少。外周血CD3、CD4、CDS可以作为卡介苗灌注治疗 有效与否的预测指标。
Objective: Transitional cell carcinoma in the bladder is the most frequent tumour in the urinary system. These tumours demonstrat a higher tendency to recur either the same stage or as deeply invasive tumours after initial surgical resection. The Bacillus Calmette-Guerin (BCG) is an effective intravesical immunomodultor in preventing the recurrence and progression of the transitional cell carcinoma. The mechanism of action of intracavitary instillation with BCG remains partially known. Some evidences demonstrated that intracavitary BCG instillations improves the local and systemic immune response. The purpose of this study investigats the quantitative nanlysis of T lymphocyte subsets in the patients peripheral blood after intracavitary instill-lation BCG, in this way to know the influence of the systemic immune responses after different dose of BCG intracavitary instillation and its predictive value and the side effects of BCG.Materials and Methods: A total of 63 patients with transitional cell carcinoma in the bladder were randomlydivided in two groups in our investigative period. They were treated with the doses of 60mg or 120mg BCG respectively. Instillation were repeated once a week for 6 weeks. The regimen was 6 weeks. Blood samples were obtained before and after regimen within 24 hours. These samples were quantitatively analysed with flow cytometery .Results: Two groups patients treated with dosage 60mg or 120mg BCG respectively. The parameter CD3 CD4 CDS in the obtained blood samples were altered before and after BCG intracavitary instillation. In these parameters, the degree of CD4 were higher after instillation than before and was statistically significant increase in the same dosage, P< 0.05, but the degree of CDS were lower after instillation than before and was statistically significant decrease, P< 0.05 . The tendence of this alteration was the same. Between two groups, it did not have statistic value compared with the same parameter, P> 0.05. In the group of instillation dosage of 60mg, the side effect were much lower than the group of dosage of 120mg.Conclusion: The systemic immune responses were altered after BCG intracavitary instillation in the patients with transitional cell carcinoma in the bladder. The alteration in the systemic immune responses were the same in different groups according to T lymphocyte subsets CD3 CD4 CDS in peripheral blood. The patients who treated with the low dosage of BCG could be subjected to much lower sideeffects than the large dosage group. To test the parameter CD3 CD4 CDS in the peripheral blood may have predictive value in the patients who treated with BCG.
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