目的:探讨新辅助化疗对直肠癌患者免疫功能、血管内皮功能及瘦素(LEP)的影响。方法:回顾性分析拟行腹腔镜直肠癌根治术患者110例的临床资料,依据手术方式分为对照组(n=55)和研究组(n=55)。对照组采用腹腔镜手术,研究组采用腹腔镜手术联合新辅助化疗治疗。于治疗前1 d、治疗后1 d采血测定肿瘤标志物CA242和CA19-9,免疫功能指标C3、C4、IgA、IgG,血管内皮功能VEGF和VEGFR-2及LEP、IGF-1水平。结果:治疗前,两组血清CA242、CA19-9、C3、C4、IgA、IgG、VEGF、VEGFR-2、LEP及IGF-1水平比较,差异无统计学意义(P<0.05)。治疗后,两组血清CA242和CA19-9水平显著降低(P<0.05)。研究组CA242和CA19-9水平显著低于对照组(P<0.05)。治疗后,两组血清IgA和IgG水平显著升高(P<0.05),研究组C3和C4水平显著上升。研究组C3、C4、IgA和IgG水平均显著高于对照组(P<0.05)。治疗后,两组血清VEGF和VEGFR-2水平显著降低(P<0.05)。研究组VEGF和VEGFR-2水平显著低于对照组(P<0.05)。治疗后,两组血清LEP水平上升,IGF-1水平显著降低(P<0.05)。研究组LEP明显高于对照组,IGF-1水平明显低于对照组(均P<0.05)。结论:腹腔镜直肠癌手术联合新辅助化疗能够明显改善直肠癌患者血管内皮功能,提高机体免疫功能,值得临床推广应用。

Objective:To investigate the effect of neoadjuvant chemotherapy on immune function, vascular endothelial function and LEP in patients with rectal cancer. Methods: The clinical data of 110 patients undergoing laparoscopic rectal cancer radical resection in our hospital were retrospectively analyzed. They were divided into control group (n=55) and study group (n=55) according to the surgical procedure. The control group was treated with laparoscopic surgery, and the study group was treated with laparoscopic surgery combined with neoadjuvant chemotherapy. The tumor markers CA242 and CA19-9, immunological function indicators C3, C4, IgA, IgG, vascular endothelial function VEGF and VEGFR-2, LEP and IGF-1 were detected at 1 day before treatment and 1 day after treatment. Results: Before treatment, serum CA242, CA19-9, C3, C4, IgA, IgG, VEGF, VEGFR-2, LEP and IGF-1 levels were not significantly different between the two groups (P<0.05). After treatment, serum CA242 and CA19-9 levels were significantly lower in the two groups (P<0.05). The levels of CA242 and CA19-9 in the study group were (15.23±1.53) IU/mL and (20.13±2.01) U/mL, which were significantly lower than the control group (P<0.05). After treatment, serum IgA and IgG levels were significantly higher in both groups, and C3 and C4 levels were significantly increased in the study group (P<0.05). The levels of C3, C4, IgA and IgG in the study group were significantly higher (1.31±0.13) g/L, (0.34±0.03)g/L, (1.78±0.18)g/L and (11.02±1.13) g/L, which were higher those in the control group (P<0.05). After treatment, serum VEGF and VEGFR-2 levels were significantly lower in the two groups (P<0.05). The levels of VEGF and VEGFR-2 in the study group were (118.15±11.86) ng/L and (92.44±9.26) ng/L, which were significantly lower than those in the control group (P<0.05). After treatment, LEP levels were significantly increased in both groups, and IGF-1 levels were significantly lower in both groups (P<0.05). The LEP of the study group was (7.51±0.71) ng/mL, which were significantly higher than that of the control group, and the level of IGF-1 was (281.47±28.86) μg/L in the study group,which were significantly lower than the control group (both P<0.05). Conclusion: Laparoscopic rectal cancer surgery combined with neoadjuvant chemotherapy can significantly improve the vascular endothelial function of patients with rectal cancer and improve the immune function of the body. It is worthy of clinical application.

R735.37

广西高校桂西地区高发病防治研究重点实验室开放课题(Kfkt2016002)