【摘要】背景与目的 机体的免疫功能异常与恶性肿瘤的发生、发展、转移及预后密切相关。T淋巴细胞亚群是反映细胞免疫功能的重要指标之一。本实验研究晚期肺腺癌患者一线化疗后外周血T淋巴细胞数量的动态变化，探讨化疗后机体免疫状态变化的动态过程，为制定化疗联合免疫治疗方案提供实验依据。方法 49例经病理学确诊的IIIb期-IV期肺腺癌患者，与33例正常人比较外周血T淋巴细胞数量。然后患者随机进入2个实验组，分别采用培美曲塞、顺铂联合方案及多西他赛、顺铂联合方案化疗，应用流式细胞仪检测化疗前后不同时间点淋巴细胞的组成。结果 肺癌患者的CD3⁺、CD3⁺CD4⁺、CD4⁺CD25⁺等T细胞的数量与健康对照组比较存在差异，P值分别为0.012，0.034和0.006；化疗后第4天及第7-10天CD3⁺、CD3⁺CD4⁺比例升高，至第21天逐渐恢复至治疗前水平；2个化疗组比较CD3⁺细胞比例均升高，而培美曲塞组第4天CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺升高，CD3⁺CD8⁺及CD8⁺CD28^-比例降低，差异均具有统计学意义。部分缓解患者较早期疾病进展患者的第4天及第7-10天CD3⁺CD4⁺细胞升高；第4天CD3⁺CD8⁺、CD8⁺CD28^-细胞降低。结论 晚期肺腺癌患者免疫功能处于抑制状态。化疗后第4天免疫功能得到一定程度恢复，至第21天恢复至治疗前水平。培美曲塞似乎对化疗后短期内免疫功能的改善有更明显的作用。化疗后免疫格局的改变可能与预后有关。

【Abstract】Background and objective The immune function disorder relates closely to the occurrence, metastasis, and prognosis of cancer. T lymphocyte subsets take an important role in immune function. We identified the dynamic changes of the immune system by investigating the levels of T lymphocyte subsets in peripheral blood of lung cancer patients with advanced stage adenocarcinoma undergoing first line chemotherapy. The results aided the search for rational chemoimmunotherapy strategies in lung cancer treatment. Methods Samples from 49 patients with pathologically demonstrated advanced stage adenocarcinoma cell lung cancer were compared with those from 33 healthy donors. Subsequently, the patients were separately treated with Docetaxol-based or Pemetrexed-based therapy. Peripheral blood samples at different time points after therapy were analyzed by flowcytometry. The lymphocyte subsets of the total lymphocytes were compared. Independent sample t test was used for the quantitative data analysis. Results The percentage of CD3⁺, CD3⁺CD4⁺, CD4⁺CD25⁺ cells of the lung cancer patients significantly varied from those of the healthy donors, the P values are 0.012, 0.034 and 0.006 separately. The CD3⁺ and CD3⁺CD4⁺ levels increased significantly on the 4^th and 7^th-10^th day post-chemotherapy, which return to normal levels on the 21^th day. The CD3⁺ level increased significantly both in the treatment group on all time points, while the CD3⁺, CD3⁺CD4⁺, CD4⁺/CD8⁺ levels significantly increased and the CD3⁺CD8⁺, CD8⁺CD28^- levels significantly decreased on the 4^th day in Pemetrexed group. The CD3⁺CD4⁺ levels increased significantly on the 4^th and 7^th-10^th day and the CD3⁺CD8⁺, CD8⁺CD28^- levels decreased on the 4^th day in partial response group. Conclusion The immune function of advanced stage adenocarcinoma cell lung cancer patients was evidently suppressed, and was restored at the 4^th day, followed by a reduction at the 21^st day after chemotherapy. On the 4^th day, Pemetrexed showed better effect on the immune system. The change of immune system post-chemotherapy could be related with the prognosis.