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目的观察手术、化疗、免疫制剂对围手术期胃癌患者免疫功能的影响,探讨干扰素α1b(IFN-α1b)在胃癌综合治疗中的作用。方法49例胃癌患者分为3组:A组10例,为手术组,观察期间未给予化疗或IFN-α1b;B组18例,为化疗组,应用5-Fu;C组21例,为免化组,应用5-Fu+IFN-α1b。术前、术后2、4、6周检测T细胞亚群(CD4、CD8)及自然杀伤细胞(NK),监测肿瘤标志(TMs,包括胃癌抗原MG7、CEA、CA19-9),并对部分病例(应用IFN-α1b的IFN组,12例;对照组CTL组,包括单纯手术组及化疗组,11例)随访。结果胃癌患者免疫功能在术后继续削弱;化疗可损害免疫功能,IFN-α1b治疗6周以上可减轻免疫损伤。MG7的阳性率是69.38%。术前TMs升高者术后MG7下降,如联合检测则部分患者于术后3个月TMs再度升高。IFN组与CTL组的中位生存时间分别为44及30个月,两组间无差异(P>0.05)。结论IFN-α1b可减轻化疗的免疫损伤,但需应用较长时间;IFN-α1b不影响胃癌患者的生存时间;MG7可用于胃癌的术后监测及随访。
Objective To observe the effects of surgery, chemotherapy and immune preparations on immune function in patients with gastric cancer during perioperative period and to explore the role of interferon α1b (IFN-α1b) in the comprehensive treatment of gastric cancer. Methods 49 cases of gastric cancer patients were divided into 3 groups: group A, 10 cases were surgery group, no chemotherapy or IFN-α1b was given during the observation period; 18 cases in group B were chemotherapy group, 5-Fu group and 21 cases in group C Group, the application of 5-Fu + IFN-α1b. T cell subsets (CD4, CD8) and natural killer cells (NK) were detected preoperatively and at 2, 4 and 6 weeks after operation, and tumor markers (TMs including MG7, CEA and CA19-9) Cases (IFN-α1b IFN group, 12 cases; control group CTL group, including simple surgery group and chemotherapy group, 11 cases) were followed up. Results The immune function of gastric cancer patients continued to be weakened after operation. Chemotherapy could impair the immune function. Treatment with IFN-α1b for more than 6 weeks could reduce the immune damage. The positive rate of MG7 was 69.38%. Preoperative TMs elevated MG7 decreased after surgery, such as joint detection of some patients at 3 months after TMs again increased. The median survival time of IFN group and CTL group were 44 and 30 months, respectively, with no difference between the two groups (P> 0.05). Conclusion IFN-α1b can reduce the immunological damage induced by chemotherapy, but it should be applied for a long time. IFN-α1b does not affect the survival time of gastric cancer patients. MG7 can be used for postoperative monitoring and follow-up of gastric cancer.