| Objective: Esophageal carcinoma is a common malignanttumor which threatens human beings seriously. It is consideredthat esophageal carcinoma is a systemic disease rather than alocal disease. Investigation on immunology of tumor patientsshowed that immune function decreases in these patients.Further, surgical operation and general anesthesia would alsosuppress immune function. It is recommended that the treatmenton carcinoma should take the patient as a total body. As asystemic treatment method, iRNA was emphasized strongly inthe combined treatment of esophageal carcinoma in near years.Immune RNA is a kind of biological preparation, which cantransfer special immune function to normal cells. It can alsotransfer and establish specific immunity between differentspecies. Immune RNA has been used to treat neoplasm for manyyears. However, it has specificity in delivering information, andthere is no cross reaction in various tumor antigens. So, thetreatment effects of iRNA were limited. The autologous tumoriRNA, which produced by immune animal vaccinated byautologous tumor tissues, can eliminate these effects. So, itshould be a more ideal method than that of allogenic iRNA. Inthis study, the immune function of patients with esophagealcarcinoma was detected by flow cytometry and argentophilicstaining in the period of perioperation and after immune treatedby autologous tumor iRNA. Then, these results were analysedwith the near survival rate. The aim of this study was to clarifythe effects of operation to immune function, and to elucidate theanti-tumor mechanism of iRNA.Methods:From March 2003 to August 2003, sixtycases ofesophageal carcinoma patients were selected in Fourth Hospitalof Hebei Medical University. All patients were diagnosed asesophageal squmous cell carcinoma by endoscope and biopsy.They were divided into two groups at random: the treatmentgroup and the control group, with 30 cases in each group. Theratios of male and female patients were equal in two groups, sowere the lesion sites(the upper,middle and lower partcarcinoma). The average ages of the treatment group and controlgroup were 57.2 and 56.9, respectively, whichhad no significantdifference (P>0.05). All patients in the two groups were in stageⅢaccording to pTNM staging system proposed by UICC.Distant metastasis was not found by clinical examination beforesurgical operation. They were no severe disease, such ashepatorenal function failure, endocrine and allergic disease,found by preoperative examination. All patients in two groupsconsented to the project and signed a file before operation. Freshtumor specimens (approximate 2.0g) of the treatment groupwere obtained immediately after the tumor was resected inoperating room. The obtained tumor specimens were flushed bynormal saline immediately and preserved at -20℃and sent tothe department of laboratory animal of Hebei MedicalUniversity where the iRNA was made. At 28 days afteroperation, the patients of treatment group were vaccinated bythe autologous iRNA 2mg every two days for 20 times together.Peripherial venous blood of all the patients was collected beforeoperation, 28 and 75 days after operation. The numbers of CD4~+,CD8~+, CD4~+/CD8~+ and NK cell activity were determined byflow cytometry. The contents of T lymphocyte Ag-NORs weredetected by argentophilic staining. The side-effects and nearsurvival rates were investigated by clinical follow-up study. Thepercentage of the square of Ag-NORs in nucleus was used todescribe the content of Ag-NORs. The number of T lymphocytesubgroup was described by the percentage of the positive cellswhich were stained.Results: 1 Before operation, there was no significantdifference in the Ag-NORs number between the treatment group(5.23±0.45) % and control group (5.19±0.39) % (P>0.05). Thenumber of CD4~+,CD8~+,CD4~+/CD8~+ and NK cell activity were(29.51±8.72)%,　(31.92±6.87)%,　1.15±0.19 and(12.07±5.23)% , respectively, in treatment group and were(30.17±9.23)%,　(32.24±6.34)%,　1.11±0.22 and(11.68±4.82)%, respectively, in control group. There were nosignificant difference between the two groups (P>0.05). All ofthem were lower than normal values. 2 At 28 days afteroperation, there was no significant difference in the Ag-NORsnumber between the treatment group (5.86±0.77)% and controlgroup (5.92±0.79)%(P>0.05). The number of CD4~+,　CD8~+,　CD4~+/CD8~+ and NK cell activity were (37.45±6.37)%,　(28.57±5.41)%,　1.47±0.35 and (15.25±4.77)%, respectively,in treatment group and were (36.59±7.08)%,　(27.92±4.53)%,　1.41±0.38 and (14.82±5.02)%, respectively, in control group.There were no significant difference between the two groups(P>0.05). 3 At 75 days after operation, the Ag-NORs numberwas (7.15±0.54) % and (6.27±0.32) %. There was significantdifference between the two groups (P<0.05). The number ofCD4~+,　CD8+,　CD4~+/CD8~+ and NK cell activity were(49.31±5.25),　(26.52±2.98)%,　1.78±0.42 and(24.35±4.02)% ,respectively, in treatment group and were(46.69±4.19)%,　(26.96±2.57)%,　1.62±0.31 and(21.47±3.79)% ,respectively ,in control group. It showed thatthe number of CD4~+,CD4~+/CD8~+ and NK cell activity hadsignificant difference between the treatment group and controlgroup(P<0.05). There was no significant difference in thenumber of CD8+ between the two groups (P>0.05). 4Clinicalfollow-up study showed that the 6-month,　12-month and18-month survival rate were 100 % ,96.67 % and 93.33%,respectively, in treatment group and were 96.67%,90% and86.67%. It is higher than control group. 5 The patients oftreatment group tolerated well without heavy side-effects suchas ulceration, allergy, shock and so on. Conclusions: 1 The immune function of patients withesophageal carcinoma is lower than normal values. Tlymphocyte Ag-NORs can be used as a diagnostic marker ofesophageal carcinoma, and apply to the screen of high-incidencepeople. 2 After operation, the immune function of patients with... |
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