摘要目的 研究在超声引导下微波凝固治疗肝癌后瘤区注射超抗原(高聚生)对机体局部细胞免疫水平的影响.方法 92例原发性肝癌患者,分为单纯微波治疗组(A组,45例)和微波治疗后瘤区注射高聚生组(B组,47例),于微波治疗前后和高聚生瘤区注射前后进行超声引导下肝组织活检穿刺取材.采用免疫组化染色法,比较两组标本组织中免疫细胞CD3+、CD4+、CD57+和CD68+局部浸润情况的变化.在电镜下观察高聚生注射后局部浸润免疫细胞的功能状态.结果 高聚生注射后1周,B组标本组织中CD3+、CD4+、CD57+和CD68+细胞的密度值分别为54.50±18.44、38.14±12.44、33.38±10.79和45.56±16.53,较微波治疗前及高聚生注射前均有不同程度的增高(均P<0.05);高聚生注射后4周,B组CD3+、CD4+、CD57+和CD68+细胞的密度值分别为32.67±10.42、23.43±6.99、18.63±7.89和30.01±11.05,仍高于微波治疗前的水平(P<0.05).微波治疗后5周,B组标本组织中CD3+、CD4+、CD57+和CD68+细胞的密度值分别为54.50±18.44、38.14±12.44、33.38±10.79和45.56±16.53,明显高于A组(32.03±8.11、15.67±8.32、15.23±8.26和29.67±11.98,P<0.05).透射电镜观察结果 显示,高聚生局部注射后,B组标本组织中局部浸润的免疫细胞内可见较多的溶酶体、内质网和线粒体等.结论 超声引导瘤区注射超抗原协同微波治疗肝癌能进一步增强肝癌患者的局部抗肿瘤细胞免疫水平.

abstractsObjective To investigate the local cellular immune response after injection of superantigen, the highly agglutinative staphylococin (HAS), into the tumor bed after ultrasound-guided percutaneous microwave coagulation therapy (PMCT) in the liver cancer patients. Methods Ninety-two patients with pathologically proven primary liver cancer were divided into two groups: 45 in group A were treated by PMCT alone and 47 in the group B by combined with ultrasound-guided percutaneous injection of highly agglutinative staphylococcin (HAS). Before and after PMCT and HAS treatment, the patients underwent ultrasound-guided percutaneous biopsy from the tumor bed and the samples were examined by pathology and immunohistochemistry. The infiltration of CD3+ , CD4+ , CD57+ and CD68+ lymphocytes in treatment zone was compared between the two groups. Moreover, the infiltrating immunocytes were observed by transmission electron microscopy. Results One week after HAS injection, the densities of CD3+, CD4+ , CD57+ and CD68+ cells in the group B were 54.50±18.44,38.14±12.44,33.38±10.79 and 45.56 ±16.53, respectively. All the above mentioned parameters increased significantly in varying degrees compared with that before PMCT or HAS injection (P < 0.05). Four weeks after HAS injection, the density ofCD3+ , CD4+ , CD57+ and CD68+ cells in the group B were 32.67 ±10.42, 23.43 ±6.99, 18.63± 7.89 and 30.01 ± 11.05, respectively, still significantly higher than those before PMCT (P < 0.05 ). Five weeks after PMCT and HAS injection, the densities of CD3+, CD4+ , CD57+ and CD68+ cells in the group B were 54.50 ± 18.44,38.14 ± 12.44,33.38 ± 10.79 and 45.56 ± 16.53, versus 32.03 ± 8.11, 15.67 ± 8.32, 15.23 ± 8.26 and 29.67 ± 11.98 in the group A, respectively, still with a significant difference between the two groups ( P < 0.05 ). A lot of lysosomes, endoplasmic reticulum and mitochondria in the immune cells after injection of HAS were observed by transmission electron microscopy. Conclusion The local cellular immunity in liver cancer treatment area can be significantly improved by ultrasound-guided injection of highly agglutinative staphylococin after percutaneous microwave coagulation therapy.