非小细胞肺癌胸腔镜下亚肺叶切除术后患者肿瘤标志物、红细胞免疫功能及外周血P选择素、CD63的变化情况

Changes of tumor markers, erythrocyte immunity and peripheral blood CD62P and CD63 in patients with non-small cell lung cancer after thoracoscopic sublobectomy

摘要:

目的 探讨胸腔镜下亚肺叶切除术对非小细胞肺癌（NSCLC）患者肿瘤标志物、红细胞免疫功能及外周血P选择素（CD62P）、CD63水平的影响。方法 选取2015年1月－2018年2月该院NSCLC患者85例，根据治疗术式不同分为亚叶切除术组（n = 43）和肺叶切除术组（n = 42）。亚叶切除术组行胸腔镜下亚肺叶切除术，肺叶切除术组行胸腔镜下肺叶切除术。比较两组患者围术期手术相关指标、并发症、手术前后血清肿瘤标志物［癌胚抗原（CEA）、糖类抗原50（CA50）、细胞角质蛋白19片段抗原21-1（CYFRA21-1）］、血浆红细胞免疫功能指标［红细胞免疫复合物花环率（RBC-ICR）、自然肿瘤红细胞免疫花环率（NTER）、红细胞免疫亲和力受体（FEER）、协同肿瘤红细胞花环率（ATER）］、外周血CD62P和CD63水平，统计术后1和3年患者生存率和复发率。结果 亚叶切除术组手术时间、住院时间较肺叶切除术组短，术中出血量、闭式引流时间 > 48 h比例较肺叶切除术组少，术后1 d的视觉模拟评分（VAS）较肺叶切除术组低（P < 0.05）；两组患者术后3和7 d血清CEA、CA50、CYFRA21-1与外周血CD62P、CD63水平均较术前降低（P < 0.05），但组间比较，差异无统计学意义（P > 0.05）；亚叶切除术组术后3和7 d血浆RBC-ICR水平均低于肺叶切除术组，NTER、FEER、ATER水平均高于肺叶切除术组（P < 0.05）；亚叶切除术组术后并发症发生率为9.30%，低于肺叶切除术组的26.19%（P < 0.05）；两组患者术后1和3年生存率、复发率比较，差异均无统计学意义（P > 0.05）。结论 胸腔镜下亚肺叶切除术治疗NSCLC，不仅能降低肿瘤标志物及外周血CD62P、CD63水平，还能减轻手术创伤、促进术后恢复、降低并发症发生率及减少对机体红细胞免疫功能的影响，且对预后无不良影响，疗效较好，安全性高。

Abstract:

Objective To investigate the effects of thoracoscopic sublobectomy on tumor markers, erythrocyte immunity, and peripheral blood CD62P and CD63 levels in patients with non-small cell lung carcinoma (NSCLC).Methods 85 patients with NSCLC in cardiothoracic surgery from January 2015 to February 2018 were selected and divided into sublobectomy group (n = 43) and lobectomy group (n = 42) according to different treatment methods. The sublobectomy group underwent thoracoscopic sublobectomy, and the lobectomy group underwent thoracoscopic lobectomy. The perioperative indicators, complications, and serum tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 50 (CA50), cyto-keratin 19 fragment antigen 21-1 (CYFRA21-1)], plasma erythrocyte immune function indexes [red blood cell immune complex rosette (RBC-ICR), natural tumor erythrocyte rosette (NTER), regulating factors of erythrocyte immune adhesion (FEER), associated tumor erythrocyte rosette (ATER)] and peripheral blood CD62P and CD63 levels before and after the operation were compared between the two groups. The survival rate and recurrence rate of 1 and 3 years after operation were also calculated.Results The operation time and hospital stay of the sublobectomy group were shorter than those of the lobectomy group. The intraoperative blood loss, closed drainage time > 48 h were less than those of the lobectomy group, and the VAS score at 1 day after the operation was lower than that of lobectomy group (P < 0.05). The levels of serum CEA, CA50, CYFRA21-1 and peripheral blood CD62P and CD63 levels in the two groups at 3 and 7 days after surgery were lower than those before the surgery (P < 0.05), but there was no statistically significant difference between the two groups (P > 0.05). The plasma RBC-ICR levels of the sublobectomy group were lower than those of the lobectomy group at 3 and 7 days after the operation, and the levels of NTER, FEER, and ATER were higher than those of the lobectomy group (P < 0.05). The postoperative complication rate in the sublobectomy group was 9.30%, it was lower than that in the lobectomy group with 26.19% (P < 0.05). There were no statistically significant difference in the survival rate and recurrence rate between the two groups at 1 and 3 years after surgery (P > 0.05).Conclusion The application of thoracoscopic sublobectomy for the treatment of NSCLC patients can not only reduce tumor markers and peripheral blood CD62P and CD63 levels, but also reduce surgical trauma, promote postoperative recovery, reduce the incidence of complications and the impact on the body’s erythrocyte immune function, and has no adverse effects on the prognosis, the definite curative effect and high safety.