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目的乳腺癌患者术后新辅助化疗可提高患者的生存期,但其免疫学机制不清,本文旨在探讨新辅助TAC化疗对患者细胞免疫功能和Ki-67表达的影响。方法选择2013年6月—2015年7月在鄞州人民医院确诊并接受新辅助化疗的90例早期乳腺癌患者按照随机数字表法分为对照组45例和试验组45例,术后对照组采用CEF方案治疗,试验组采用TAC方案,1个疗程/3周,共4个疗程。观察2组患者的临床疗效和不良反应,采用流式细胞仪检测全血CD3、CD4、CD8、自然杀伤细胞(NK)水平,采用ELISA检测肿瘤坏死因子-α(TNF-α)、白介素-2(IL-2)、白介素-6(IL-6)、白介素-10(IL-10)水平,免疫组织化学检测Ki-67表达。结果试验组总有效率为86.67%(39/45),高于对照组的68.89%(31/45),P<0.05。治疗后试验组患者的CD3、CD4、CD8、NK水平低于治疗前,且CD3、CD4、CD8显著低于对照组(P<0.05)。试验组患者的TNF-α和IL-2显著高于对照组,而IL-6和IL-10显著低于对照组(P<0.05)。治疗后2组患者Ki-67阳性率为53.33%(24/45)、57.78%(26/45),显著低于治疗前的88.89%(40/45)、84.44%(38/45),χ~2=0.997、0.402,均P<0.01,但2组间差异无统计学意义(χ~2=0.180,P=0.671)。试验组不良反应发生率37.78%(17/45)低于对照组为60.00%(27/45),χ~2=4.447,P=0.035。结论新辅助化疗TAC方案可改善早期乳腺癌患者的细胞免疫功能,降低Ki-67阳性表达,具有良好的临床疗效。
The purpose of this study was to investigate the effect of neoadjuvant TAC chemotherapy on cellular immune function and Ki-67 expression in patients with breast cancer after neoadjuvant chemotherapy can improve the survival of patients, but the immunological mechanism is unclear. METHODS: Ninety-nine patients with early-stage breast cancer who were diagnosed with neoadjuvant chemotherapy at Yinzhou People’s Hospital from June 2013 to July 2015 were divided into control group (n = 45) and experimental group (n = 45) according to random number table. CEF program treatment, the experimental group using TAC program, a course of treatment / 3 weeks, a total of 4 courses. The clinical efficacy and adverse reactions of the two groups were observed. The levels of CD3, CD4, CD8 and NK cells in whole blood were detected by flow cytometry. The levels of tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), interleukin-6 (IL-6) and interleukin-10 (IL-10) were detected by immunohistochemistry. Ki-67 expression was detected by immunohistochemistry. Results The total effective rate of the experimental group was 86.67% (39/45), which was higher than that of the control group (68.89%, 31/45), P <0.05. After treatment, the levels of CD3, CD4, CD8 and NK in the experimental group were lower than those before treatment, and the levels of CD3, CD4 and CD8 in the experimental group were significantly lower than those in the control group (P <0.05). The levels of TNF-α and IL-2 in the experimental group were significantly higher than those in the control group, while the levels of IL-6 and IL-10 in the experimental group were significantly lower than those in the control group (P <0.05). The positive rates of Ki-67 in two groups after treatment were 53.33% (24/45) and 57.78% (26/45), respectively, which were significantly lower than 88.89% (40/45) and 84.44% (38/45) before treatment ~ 2 = 0.997,0.402, all P <0.01, but there was no significant difference between the two groups (χ ~ 2 = 0.180, P = 0.671). The incidence of adverse reactions in the experimental group was 37.78% (17/45) lower than that in the control group (60.00%, 27/45), χ ~ 2 = 4.447, P = 0.035. Conclusion The neoadjuvant chemotherapy TAC regimen can improve the cellular immune function and reduce the expression of Ki-67 in patients with early-stage breast cancer and has good clinical efficacy.