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目的探讨培美曲塞(pemetrexed)联合顺铂(cisplatin)或卡铂(carboplatin)治疗方案对非小细胞肺癌患者外周血淋巴细胞表型的影响。方法 45例经病理学或细胞学确诊的非小细胞肺癌患者,采用培美曲塞500 mg/m2,第1天静脉滴注;顺铂25 mg/m2,第1～3天或卡铂按AUC=5计算剂量,第2天静脉滴注,21天为一周期,毎例患者至少治疗2周期,有可测量病灶者进行疗效评价。应用流式细胞仪检测化疗前和化疗后第7天外周血CD3+、CD4+、CD8+、CD16+56+、CD19+细胞的百分率和CD4+/CD8+比值。结果非小细胞肺癌患者经培美曲塞联合含铂方案化疗后CD4+、CD4+/CD8+、CD16+56+较化疗前升高(P=0.032),CD3+、CD8+、CD19+化疗前后差异无统计学意义(P>0.05);临床分期为ⅢB～Ⅳ期的患者化疗前CD3+、CD4+、CD4+/CD8+和CD16+56+较ⅠB～ⅢA期患者低(P=0.029),化疗后两者比较差异无统计学意义(P>0.05);化疗有效者CD3+、CD4+、CD4+/CD8+比值均显著增高(P=0.008)。结论非小细胞肺癌患者,尤其是晚期患者机体免疫功能低下。培美曲塞联合含铂方案化疗打破了原有的抗肿瘤免疫抑制状态,机体有可能通过免疫重建增强抗肿瘤免疫应答。
Objective To investigate the effect of pemetrexed combined with cisplatin or carboplatin on the phenotype of peripheral blood lymphocytes in patients with non-small cell lung cancer. Methods Forty-five patients with non-small cell lung cancer diagnosed by pathology or cytology were treated with pemetrexed 500 mg / m 2 intravenously on day 1; cisplatin 25 mg / m 2 on days 1 to 3 or carboplatin AUC = 5 calculated dose, intravenous drip on the 2nd day, 21 days for a cycle, patients with at least two cycles of treatment, there are measurable lesions were evaluated. Flow cytometry was used to detect the percentage of CD3 +, CD4 +, CD8 +, CD16 + 56 +, CD19 + cells and CD4 + / CD8 + ratio in peripheral blood before chemotherapy and 7 days after chemotherapy. Results The levels of CD4 +, CD4 + / CD8 + and CD16 + 56 + in patients with NSCLC after chemotherapy were significantly higher than those before chemotherapy (P = 0.032), but there was no significant difference between before and after chemotherapy with CD3 +, CD8 + and CD19 + (P> 0.05). The levels of CD3 +, CD4 +, CD4 + / CD8 + and CD16 + 56 + in patients with stage ⅢB-Ⅳ were lower than those in patients with stage ⅠB-ⅢA before chemotherapy (P = 0.029) (P> 0.05). The ratios of CD3 +, CD4 + and CD4 + / CD8 + in patients with chemotherapy were significantly higher (P = 0.008). Conclusion Non-small cell lung cancer patients, especially in advanced patients with poor immune function. Pemetrexed combined with platinum-containing chemotherapy to break the original state of anti-tumor immunosuppression, the body may enhance the anti-tumor immune response through immune reconstitution.