目的：探讨经肝动脉化疗栓塞术（TACE）联合微波消融（MVA）对中晚期肝癌细胞免疫功能和预后的影响。方法回顾性分析96例中晚期肝癌患者资料，其中55例行 TACE 联合 MVA 治疗（联合组），41例行单纯 TACE 治疗（对照组）。比较两组患者术后 CD4＋、CD8＋T 淋巴细胞、NK 细胞水平和生存情况。结果与治疗前比较，对照组术后3种免疫指标无明显变化（均 P ＞0．05），而联合组术后 CD4＋T 淋巴细胞和 NK 细胞比例逐渐上升，CD8＋T 淋巴细胞比例下降，其中治疗后1个月3种免疫指标较术前，差异有统计学意义（均 P ＜0．05）。联合组治疗后1月 CD4＋淋巴细胞和 NK 细胞比例高于对照组，CD8＋淋巴细胞比例低于对照组，且差异均有统计学意义（均 P ＜0．05）。随访时间为5．5～43．6个月。联合组1年、2年、3年总生存率分别为83．6％、52．7％、9．1％；对照组1年、2年、3年总生存率分别为70．7％、14．6％、0。两组患者的总生存率比较，差异有统计学意义（P ＝0．001）。结论较单纯 TACE 治疗，TACE 联合 MVA 治疗可以改善中晚期肝癌患者的细胞免疫功能和生存情况。%Objective To explore the impact of transcatheter arterial chemoembolization combined (TACE) with microwave ablation (MWA)on immune function and prognosis of patients with advanced hepatocellular carcinoma. Methods 96 cases with advanced hepatocellular carcinoma were reviewed.They were divided into combined group (n =55)underwent TACE combined with MVA and control group underwent TACE (n =41 ).The ratio of CD4 +T, CD8 +T and NK cells and survival rate were compared.Results In the control group,no difference in the three immunity index were observed between preoperative and postoperative (all P >0.05).In the combined group,the ratio of CD4 +T and NK cells were increased and CD8 +T cells was reduced.There were statistical difference in the three immunity index between preoperative and postoperative 1 month (all P <0.05).But in the combined group,the ratio of CD4 +T and NK cells were higher and CD8 + T cells were lower compared with those in the control group (all P <0.05).The follow -up period ranged from 5.5 to 43.6 months (20.9 ±2.3).The 1 -,2 -,and 3 -year overall survival rate in the proximal group were 83.6%,52.7% and 9.1% respectively.However the 1 -,2 -,and 3 -year overall survival rate in the total group were 70.7%,14.6% and 0,respectively.There was a significant difference in the overall survival between the two groups (P =0.001 ).Conclusions TACE combined with MVA for advanced hepatocellular carcinoma can improve the immune function and overall survival rate compared with TACE.
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