華紅霞 任國(guó)琴 孫優(yōu)苗 孫清

香菇多糖對(duì)老年乳腺癌化療病人T細(xì)胞亞群及血清IL-2、IL-6的影響

華紅霞 任國(guó)琴 孫優(yōu)苗 孫清

目的 探討香菇多糖對(duì)老年乳腺癌化療病人T細(xì)胞亞群及血清白細(xì)胞介素-2(IL-2)、白細(xì)胞介素-6(IL-6)的影響。 方法 將80例于我院進(jìn)行治療的老年乳腺癌病人隨機(jī)分為對(duì)照組和觀察組,每組各40例。對(duì)照組病人進(jìn)行化療,觀察組在對(duì)照組的基礎(chǔ)上靜脈滴注香菇多糖注射液,比較2組治療前、后T細(xì)胞亞群(CD4+、CD8+、CD4+/CD8+)及血清IL-2、IL-6水平的變化。 結(jié)果 對(duì)照組治療后CD4+及CD4+/CD8+均較治療前顯著降低,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),觀察組治療前后CD4+、CD8+及CD4+/CD8+比較差異均無統(tǒng)計(jì)學(xué)意義(P>0.05),且治療后觀察組CD4+及CD4+/CD8+均顯著高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);與治療前比較,治療后,觀察組IL-2水平顯著升高,對(duì)照組顯著降低(P<0.05),觀察組IL-6水平顯著降低,對(duì)照組顯著升高(P<0.05);治療后2組間IL-2、IL-6水平比較,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組不良反應(yīng)發(fā)生率為50.00%,顯著低于對(duì)照組的80.00%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。 結(jié)論 香菇多糖輔助乳腺癌病人化療,能夠顯著提高老年化療病人CD4+細(xì)胞活性,改善體內(nèi)IL-2、IL-6水平,調(diào)節(jié)人體免疫功能,減輕免疫抑制。

乳腺癌; 香菇多糖; T細(xì)胞亞群; IL-2; IL-6

乳腺癌是女性最常見的惡性腫瘤之一,是乳房腺上皮細(xì)胞在多種致癌因子聯(lián)合作用下,發(fā)生基因突變引起的細(xì)胞增生失控。有些乳腺癌病人在疾病早期確診并接受治療,預(yù)后相對(duì)較好,但很多病人確診時(shí)已處于癌癥晚期,失去了手術(shù)治療的機(jī)會(huì),只能進(jìn)行化療[1-3]。長(zhǎng)期化療會(huì)導(dǎo)致病人骨髓抑制及免疫抑制,影響病人預(yù)后。香菇多糖是從香菇的實(shí)體中分離出來的,可抑制腫瘤的增殖,提高免疫功能,減輕化療不良反應(yīng)[4-5]。本研究旨在探討香菇多糖對(duì)老年乳腺癌化療病人T細(xì)胞亞群及血清白介素(IL)-2、IL-6的影響,現(xiàn)報(bào)道如下。

1 資料與方法

1.1 一般資料 將80例2011年6月至2015年5月于我院進(jìn)行化療的老年乳腺癌病人按隨機(jī)對(duì)照表法分為觀察組和對(duì)照組,每組各40例。觀察組年齡60～85歲,平均(72.74 ± 12.72)歲;卡氏(KPS)功能狀態(tài)評(píng)分82～92分,平均(86.43±5.59)分。對(duì)照組年齡60～86歲,平均(73.01± 13.05)歲;KPS評(píng)分80～93分,平均(86.85±5.66)分。納入標(biāo)準(zhǔn):所有病人均符合乳腺癌相關(guān)診斷標(biāo)準(zhǔn);病人KPS功能狀態(tài)評(píng)分≥80分;排除標(biāo)準(zhǔn):化療禁忌證病人;有化療、放療史病人;心、肝、腎功能不全病人;有糖尿病、高血壓、血液系統(tǒng)疾病病人。本研究經(jīng)倫理委員會(huì)審核通過;所有病人均自愿加入本試驗(yàn),且簽訂知情同意書。2組病人年齡、KPS評(píng)分等一般資料比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。

1.2 方法 2組病人均通過TA(紫杉醇、阿霉素)化療方案進(jìn)行治療,觀察組在化療方案的基礎(chǔ)上加用注射用香菇多糖(南京綠葉思科藥業(yè)有限公司生產(chǎn),規(guī)格:1 mg/支)。將1 mg香菇多糖溶于 250 ml 5%葡萄糖注射液中靜脈滴注,每周2次。21 d為1個(gè)化療周期,共化療4周期,4周期后比較2組治療前后T細(xì)胞亞群及血清IL-2、IL-6水平變化。

1.3 觀察指標(biāo) 治療前、后采集病人清晨空腹靜脈血進(jìn)行各指標(biāo)測(cè)定。采用流式細(xì)胞儀及配套試劑檢測(cè)外周血T細(xì)胞亞群:血細(xì)胞簇分化抗原(CD4+、CD8+、CD4+/CD8+),嚴(yán)格按照說明書進(jìn)行操作;采用液相平衡競(jìng)爭(zhēng)放射免疫分析法測(cè)定病人血清IL-2、IL-6水平。記錄2組治療期間出現(xiàn)的不良反應(yīng)。

2 結(jié)果

2.1 治療前、后2組病人T細(xì)胞亞群變化比較 治療前2組T細(xì)胞亞群各指標(biāo)比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05);與治療前比較,治療后對(duì)照組CD4+、CD4+/CD8+顯著降低(P<0.05),CD8+無明顯變化(P>0.05);觀察組CD4+、CD8+及CD4+/CD8+均無明顯變化(P>0.05)。治療后2組病人CD8+水平差異無統(tǒng)計(jì)學(xué)意義(P>0.05),觀察組CD4+、CD4+/CD8+水平顯著高于對(duì)照組(P<0.05)。見表1。

表1 2組病人治療前、后CD4+、CD8+及CD4+/CD8+水平比較

注:與治療前比較,*P<0.05;與對(duì)照組比較,△P<0.05

2.2 治療前、后2組病人IL-2、IL-6水平變化比較 治療前2組IL-2、IL-6比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05);與治療前比較,治療后觀察組IL-2顯著升高,IL-6顯著降低,對(duì)照組IL-2顯著降低,IL-6顯著升高,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后觀察組IL-2顯著高于對(duì)照組,IL-6顯著低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。見表2。

表2 2組病人治療前、后IL-2、IL-6水平變化比較

注:與治療前比較,*P<0.05;與對(duì)照組比較,△P<0.05

2.3 2組不良反應(yīng)發(fā)生率比較 觀察組不良反應(yīng)發(fā)生率為50.00%,顯著低于對(duì)照組的80.00%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。見表3。

表3 2組不良反應(yīng)發(fā)生率比較(n,n=40)

3 討論

乳腺癌是女性常見的癌癥之一,是指乳房腺上皮細(xì)胞因多種致癌因子聯(lián)合作用導(dǎo)致病人基因突變,致使細(xì)胞增生失控[6]。其組織學(xué)表現(xiàn)為大量癌細(xì)胞無限增殖并無序擁擠成團(tuán),使正常組織受到擠壓和破壞,破壞乳房結(jié)構(gòu)。近年來,老年乳腺癌的發(fā)病率也逐年增加,若乳腺癌病人能夠早期診斷并接受合理治療,預(yù)后就相對(duì)較好,相反,很多病人在確診時(shí)已是癌癥晚期,失去了手術(shù)治療的機(jī)會(huì),只能進(jìn)行化療。化療在癌癥治療過程中不可或缺,但化療所引起的不良反應(yīng)，如惡心、嘔吐、食欲下降、免疫力降低等癥狀也不容忽視,這些不良反應(yīng)給病人身心帶來巨大摧殘[7-8]。如何盡可能地減輕化療的不良反應(yīng)，降低免疫抑制作用，提高病人生存質(zhì)量是目前臨床面對(duì)的重要問題。

香菇多糖是從香菇實(shí)體中分離純化出來的具有調(diào)節(jié)免疫作用的多糖,主要用于輔助治療惡性腫瘤[9-10]。香菇多糖作為生物反應(yīng)調(diào)節(jié)劑,本身并無直接的細(xì)胞毒作用,其主要是通過宿主促進(jìn)激活巨噬細(xì)胞、T細(xì)胞及NK細(xì)胞等,從而減輕免疫抑制、破壞腫瘤細(xì)胞增殖,達(dá)到抗腫瘤目的[11]。香菇多糖對(duì)實(shí)體瘤有抑制作用,可提高機(jī)體免疫功能,抑制腫瘤的增殖,從而對(duì)病人化療造成的免疫功能下降也有很好的調(diào)節(jié)作用[12-13]。

T淋巴細(xì)胞亞群的檢測(cè)是監(jiān)測(cè)免疫功能的重要方式[14]。CD4+是人體免疫系統(tǒng)中的一種重要免疫細(xì)胞,主要表達(dá)于輔助T細(xì)胞[15]。CD8+主要表達(dá)于抑制細(xì)胞殺傷性T細(xì)胞。因此當(dāng)CD4+/CD8+值發(fā)生異常時(shí),就會(huì)出現(xiàn)免疫功能紊亂。有文獻(xiàn)顯示,香菇多糖在晚期肺癌病人的治療中,可使 CD4+/CD8+值升高,改善病人免疫力[16]。本研究結(jié)果顯示,治療后,觀察組CD4+、CD4+/CD8+水平顯著高于對(duì)照組(P<0.05),不良反應(yīng)發(fā)生率低于對(duì)照組。這表明香菇多糖可減輕化療藥物對(duì)老年乳腺癌化療的不良反應(yīng),調(diào)節(jié)免疫功能。

IL-2又稱T細(xì)胞生長(zhǎng)因子,能促進(jìn)細(xì)胞毒作用,調(diào)節(jié)免疫功能[5,17]。IL-6是細(xì)胞因子的核心成員,可以增強(qiáng)癌細(xì)胞活性、減少癌細(xì)胞間的黏連,且與腫瘤中的血管生成有關(guān)[18]。張雄等[19]發(fā)現(xiàn)腫瘤病人血清IL-2水平低、IL-6水平高,出現(xiàn)免疫抑制狀態(tài),是腫瘤復(fù)發(fā)的因素之一。本研究結(jié)果顯示,治療后,觀察組IL-2顯著升高(P<0.05),對(duì)照組IL-2顯著降低(P<0.05),觀察組IL-6顯著降低(P<0.05),對(duì)照組IL-6顯著升高(P<0.05),2組間IL-2、IL-6水平比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)?；煏?huì)引起免疫增強(qiáng)因子IL-2降低,免疫抑制因子IL-6升高,也反映了化療對(duì)免疫功能的抑制作用,而通過香菇多糖輔助治療可明顯削弱免疫抑制作用。

綜上所述,香菇多糖輔助乳腺癌病人化療,能夠顯著提高老年化療病人CD4細(xì)胞活性,改善體內(nèi)IL-2、IL-6水平,調(diào)節(jié)人體免疫功能,減輕免疫抑制。

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Effect of lentinan on T cell subsets, IL-2 and IL-6 in elderly patients with breast cancer receiving chemotherapy

HUAHong-xia,SUNYou-miao,SUNQing.DepartmentofOncology;RENGuo-qin.

DepartmentofNursing,WuxiSecondPeople’sHospital,Wuxi214002,China

Objective To investigate the effect of lentinan on T cell subsets, IL-2 and IL-6 in elderly patients with breast cancer receiving chemotherapy. Methods A total of 80 elderly patients with breast cancer were randomly divided into control group (n=40) and treatment group (n=40). The two groups recieved treatment with chemotherapy, and the observation group was additionally given lentinan. The levels of T cell subsets, IL-2 and IL-6 of two groups were compared. Results After treatment, the levels of CD4+and CD4+/CD8+decreased significantly in control group (P<0.05), while showing no significant difference in observation group (P>0.05). The levels of CD4+and CD4+/CD8+in observation group were significantly higher than those in control group (P<0.05). Compared with before treatment, the level of IL-2 increased significantly in observation group after treatment (P<0.05) and decreased significantly in control group (P<0.05), and the level of IL-6 decreased significantly in observation group (P<0.05) and increased significantly in control group (P<0.05). There was significant difference in levels of IL-2 and IL-6 between two groups (P>0.05). The incidence of adverse reaction in observation group(50.00%) was significantly lower than that in control group(80.00%). Conclusions Lentinan can enhance CD4+activity, improving the levels of IL-2 and IL-6, regulating immune function in elderly patients with breast cancer receiving chemotherapy.

breast cancer; lentinan; T cell subsets; IL-2; IL-6

214002江蘇省無錫市，無錫市第二人民醫(yī)院腫瘤科(華紅霞，孫優(yōu)苗，孫清)；護(hù)理部(任國(guó)琴)

任國(guó)琴，Email：renguoqin365@163.com

R 737.9

A

10.3969/j.issn.1003-9198.2017.02.016

2016-03-16)