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目的探讨选择性肾动脉栓塞术(transcatheter renal arterial embolization,TRAE)联合氩氦冷冻消融治疗对晚期肾癌患者外周血CD4+、CD25+调节性T细胞(Treg)的影响及临床意义。资料与方法晚期肾癌患者44例,分别于治疗前、后1～6个月取外周血,流式细胞仪检测外周血T淋巴细胞亚群(CD3+T、CD4+T、CD8+T、CD4+T/CD8+T、NK细胞、Treg细胞)变化情况;术后1个月采用增强MRI或CT或正电子发射体层摄影(PET-CT)评价肿瘤坏死情况。结果治疗后3个月Treg细胞比例[(3.36±1.12)%]与术前[(4.75±1.66)%]比较明显降低,差异具有统计学意义(t=16.865,P<0.01);CD3+T、CD4+T、CD4+T/CD8+T、NK细胞比例较术前明显增高,CD8+T细胞比例明显降低(P<0.01)。治疗后3～6个月CD3+T、CD4+T、CD4+T/CD8+T、NK、CD8+T、Treg细胞比例无明显变化,呈稳定趋势(P>0.05)。治疗后Treg细胞比例下降程度与肿瘤负荷下降程度呈正相关(r=0.944,P<0.01)。结论晚期肾癌患者经TRAE联合氩氦冷冻消融治疗后外周血T淋巴细胞亚群分布异常得到改善,Treg细胞比例变化与肿瘤负荷大小有关。
Objective To investigate the effect of transcatheter renal arterial embolization (TRAE) combined with argon-helium cryoablation on CD4 +, CD25 + regulatory T cells (Treg) in patients with advanced renal cell carcinoma and its clinical significance. Materials and Methods 44 patients with advanced renal cell carcinoma were treated with peripheral blood mononuclear cells (PBMCs) from 1 to 6 months before and after treatment. The levels of T lymphocyte subsets (CD3 + T, CD4 + T, CD8 + T, CD4 + T / CD8 + T, NK cells and Treg cells. The tumor necrosis was evaluated by enhanced MRI or CT or PET-CT one month after operation. Results The proportion of Treg cells at 3 months after treatment was significantly lower than that before operation [(4.36 ± 1.12)% vs (4.75 ± 1.66)%, t = 16.865, P <0.01) , The proportion of CD4 + T, CD4 + T / CD8 + T and NK cells was significantly higher than that before operation, and the proportion of CD8 + T cells was significantly decreased (P <0.01). There was no significant change in the proportion of CD3 + T, CD4 + T, CD4 + T / CD8 + T, NK, CD8 + T and Treg cells in 3 to 6 months after treatment, showing a stable trend (P> 0.05). The decreased proportion of Treg cells after treatment showed a positive correlation with the decrease of tumor burden (r = 0.944, P <0.01). Conclusion Abnormal distribution of T lymphocyte subsets in peripheral blood of patients with advanced renal cell carcinoma after TRAE combined with argon-helium cryoablation is improved. The proportion of Treg cells is related to tumor burden.