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背景与目的:观察复发胶质瘤患者接受射波刀治疗后外周血CD4+CD25+Neuropilin-1+调节性T细胞(Treg)的变化,分析患者的近期疗效,旨在探讨射波刀对复发胶质瘤可能的治疗机制。方法:以12名健康成年人作为对照组,用流式细胞仪检测53例手术后复发的胶质瘤患者(分为A、B两组,A组为射波刀治疗组,n=25;B组为非射波刀治疗组,仅给予保守对症治疗而未进行任何放化疗,n=28)外周血CD4+CD25+Neuropilin-1+Treg水平,并进行30月的生存随访,观察两组的近期疗效。结果:治疗前A、B两组患者外周血CD4+CD25+Neuropilin-1+Treg分别为(13.44±2.76)%和(12.91±2.87)%,明显高于对照组(2.78±1.07)%(P<0.01)。A组经射波刀治疗3月后外周血CD4+CD25+Neuropilin-1+Treg水平为(3.13±1.09)%,较治疗前明显下降(P<0.01)。B组CD4+CD25+Neuropilin-1+Treg为(16.12±2.98)%,较3月前升高,但差异无统计学意义(P>0.05)。A组缓解率为76.0%,无进展率为12.0%,进展率为12.0%;B组缓解率为10.7%,无进展率为17.9%,进展率为71.4%。A组死亡5例(20%),中位生存时间13个月(3~31月)。B组随访死亡15例(53.6%),中位生存时间7个月(1~13月)。其中两组缓解率、进展率、死亡率及中位生存时间差异有统计学意义(P<0.05)。结论:复发胶质瘤患者体内CD4+CD25+Neuropilin-1+Treg升高,外周血CD4+CD25+Neuropilin-1+Treg检测有助于监测胶质瘤复发和预后的评估;射波刀可以降低复发胶质瘤患者的CD4+CD25+Neuropilin-1+Treg水平,近期疗效优于保守治疗;射波刀治疗复发胶质瘤的机理可能与解除瘤负荷、降低CD4+CD25+Neuropilin-1+Treg、纠正机体免疫功能紊乱有关。
BACKGROUND & AIM: To observe the changes of CD4 + CD25 + Neuropilin-1 + regulatory T cells (Tregs) in peripheral blood of patients with recurrent glioma after radiosurgery and analyze the short-term curative effect of the patients. Possible mechanisms of treatment of glioma. Methods: Twelve healthy adults were used as the control group. Fifty - three patients with recurrent glioma after operation were divided into two groups (group A and group B, group A was treated with radiosurgical knife, n = 25; The patients in group B were treated with non-radio wave knife, and only received conservative symptomatic treatment without any chemoradiation and chemotherapy (n = 28). The levels of CD4 + CD25 + Neuropilin-1 + Treg in peripheral blood were measured and followed up for 30 months. The recent effect. Results: Before treatment, the CD4 + CD25 + Neuropilin-1 + Treg in peripheral blood of patients in group A and B were (13.44 ± 2.76)% and (12.91 ± 2.87)%, respectively, which were significantly higher than those in control group (2.78 ± 1.07)% <0.01). The level of CD4 + CD25 + Neuropilin-1 + Treg in peripheral blood in group A was (3.13 ± 1.09)% after 3 months of treatment with radiosurgery, which was significantly lower than that before treatment (P <0.01). The percentage of CD4 + CD25 + Neuropilin-1 + Treg in group B was (16.12 ± 2.98)%, which was higher than that in group B before 3 months, but the difference was not statistically significant (P> 0.05). In group A, the remission rate was 76.0%, the rate of progression was 12.0% and the rate of progress was 12.0%. The rate of remission in group B was 10.7%, the rate of progression was 17.9% and the rate of progress was 71.4%. A group of 5 patients died of death (20%), the median survival time of 13 months (3 to 31 months). Fifteen patients (53.6%) were followed up in group B, with a median survival time of 7 months (range, January to 13). There was a significant difference in remission rate, progression rate, mortality rate and median survival time between the two groups (P <0.05). Conclusion: CD4 + CD25 + Neuropilin-1 + Treg in patients with recurrent glioma increased, CD4 + CD25 + Neuropilin-1 + Treg in peripheral blood was helpful to monitor the recurrence and prognosis of glioma; The recent treatment of CD4 + CD25 + Neuropilin-1 + Treg in patients with recurrent glioma is better than that of conservative treatment. The mechanism of radiosophagectomy for recurrent glioma may be related to relieving tumor burden and decreasing CD4 + CD25 + Neuropilin-1 + Treg , To correct the body’s immune dysfunction.