原发性肝癌患者术前免疫因素及与病理特征的关系

doi:10.11958/20251548

天津医药 ›› 2025, Vol. 53 ›› Issue (9): 952-956.doi: 10.11958/20251548

原发性肝癌患者术前免疫因素及与病理特征的关系

周鹏鹏¹(), 丁烁², 姚卫康³, 罗祎⁴^,^△()

1 南京中医药大学太仓附属医院（太仓市中医医院）肝胆外科（邮编215400）
2 徐州新健康老年病医院（徐州市肿瘤医院北院）肝胆胰外二科
3 南京中医药大学太仓附属医院（太仓市中医医院）普外科
4 南京中医药大学太仓附属医院（太仓市中医医院）病案室

收稿日期:2025-04-16 修回日期:2025-06-06 出版日期:2025-09-15 发布日期:2025-09-16
通讯作者: ^△E-mail：13814599892@163.com
作者简介:周鹏鹏（1987），男，主治医师，主要从事肝脏肿瘤、肝脏损伤、胆道肿瘤、胆道结石及胰腺肿瘤诊疗及微创手术治疗方面研究。E-mail：18262061237@163.com

Preoperative immune factors in patients with primary hepatocellular carcinoma and their relationship with pathological characteristics

ZHOU Pengpeng¹(), DING Shuo², YAO Weikang³, LUO Yi⁴^,^△()

1 Department of Hepatobiliary Surgery, Taicang Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Taicang Hospital of Traditional Chinese Medicine), Taicang 215400, China
2 the Second Department of Hepatopancreatobiliary Surgery, Xuzhou New Health Geriatric Hospital (North Hospital of Xuzhou Cancer Hospital)
3 Department of General Surgery, Taicang Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Taicang Hospital of Traditional Chinese Medicine)
4 Record Room, Taicang Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Taicang Hospital of Traditional Chinese Medicine)

Received:2025-04-16 Revised:2025-06-06 Published:2025-09-15 Online:2025-09-16
Contact: ^△E-mail: 13814599892@163.com

周鹏鹏, 丁烁, 姚卫康, 罗祎. 原发性肝癌患者术前免疫因素及与病理特征的关系[J]. 天津医药, 2025, 53(9): 952-956.

ZHOU Pengpeng, DING Shuo, YAO Weikang, LUO Yi. Preoperative immune factors in patients with primary hepatocellular carcinoma and their relationship with pathological characteristics[J]. Tianjin Medical Journal, 2025, 53(9): 952-956.

摘要/Abstract

摘要：

目的分析原发性肝细胞癌（HCC）患者术前T淋巴细胞免疫、体液免疫变化及与病理特征的关系。方法选取择期行手术治疗的原发性HCC患者150例作为HCC组，另选取同期常规体检健康者150例作为对照组。于术前采用流式细胞仪检测外周血CD3⁺、CD4⁺、CD8⁺水平，并计算CD4⁺/CD8⁺；采用免疫透射比浊法检测外周血IgA、IgG、IgM水平；收集HCC组患者的病理学特征，比较不同病理学特征患者术前免疫指标差异，受试者工作特征（ROC）曲线评价免疫指标对病理特征的预测价值。结果 HCC组CD3⁺、CD4⁺、CD4⁺/CD8⁺水平均低于对照组，CD8⁺、IgA、IgG和IgM水平均高于对照组（P<0.05）。HCC患者中，有淋巴结转移者CD3⁺、CD4⁺、CD4⁺/CD8⁺水平低于无淋巴结转移者，CD8⁺及IgA、IgG和IgM水平均高于无淋巴结转移患者（P<0.05）。ROC曲线结果显示，CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺、IgA、IgG、IgM预测HCC患者淋巴结转移中的曲线下面积（AUC）分别为0.810、0.741、0.770、0.707、0.756、0.738和0.727。结论 HCC患者术前T淋巴细胞免疫和体液免疫均存在异常变化，且与患者淋巴结转移密切相关。

关键词: 癌, 肝细胞, 免疫, 细胞, 免疫, 体液, 术前, 病理特征

Abstract:

Objective To analyze changes of preoperative T lymphocyte immunity and humoral immunity, and their relationship with pathological characteristics in patients with primary hepatocellular carcinoma (HCC). Methods A total of 150 patients with primary HCC underwent elective surgical treatment were enrolled as the HCC group, while 150 healthy controls during the same period were enrolled as the control group. Before surgery, the levels of peripheral blood CD3⁺, CD4⁺ and CD8⁺ were detected by flow cytometry, and CD4⁺/CD8⁺was calculated. The levels of IgA, IgG and IgM in peripheral blood were detected by immunoturbidimetry. The pathological characteristics of HCC patients were collected, and the differences of preoperative immune indexes in patients with different pathological characteristics were compared. The receiver operating curve (ROC) was used to evaluate the predictive value of immune indicators for pathological characteristics. Results The levels of CD3⁺, CD4⁺and CD4⁺/CD8⁺ were lower in the HCC group than those in the control group, while levels of CD8⁺, IgA, IgG and IgM were higher in the HCC group than those in the control group (P<0.05). The levels of CD3⁺, CD4⁺and CD4⁺/CD8⁺ were lower in patients with lymph node metastasis than those of patients with distant lymph non-metastasis (P<0.05). The levels of CD8⁺, IgA, IgG and IgM were higher in patients with lymph node metastasis than those of patients without metastasis (P<0.05). The results of receiver operating characteristic (ROC) curves showed that area under the curve (AUC) values of CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺, IgA, IgG, and IgM for predicting lymph node metastasis in HCC patients were 0.810, 0.741, 0.770, 0.707, 0.756, 0.738 and 0.727. Conclusion There are abnormal changes of preoperative T lymphocyte immunity and humoral immunity in patients with primary HCC, which are closely related to lymph node metastasis.

Key words: carcinoma, hepatocellular, immunity, cellular, immunity, humoral, preoperative, pathological characteristic

中图分类号:

R735.7

图/表 5

参考文献 22

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组别		n	CD3⁺/%	CD4⁺/%	CD8⁺/%
对照组		150	71.30±3.76	48.95±5.25	25.57±2.67
HCC组		150	56.89±5.03	32.35±4.66	37.22±4.05
t			28.077^＊＊	28.953^＊＊	29.407^＊＊
组别	CD4⁺/CD8⁺		IgA/（g/L）	IgG/（g/L）	IgM/（g/L）
对照组	1.90±0.50		3.15±0.58	11.28±2.49	2.24±0.66
HCC组	0.90±0.22		6.95±1.29	16.61±3.45	6.66±1.25
t	22.392^＊＊		32.992^＊＊	15.345^＊＊	38.272^＊＊

组别		n	CD3⁺/%	CD4⁺/%	CD8⁺/%
对照组		150	71.30±3.76	48.95±5.25	25.57±2.67
HCC组		150	56.89±5.03	32.35±4.66	37.22±4.05
t			28.077^＊＊	28.953^＊＊	29.407^＊＊
组别	CD4⁺/CD8⁺		IgA/（g/L）	IgG/（g/L）	IgM/（g/L）
对照组	1.90±0.50		3.15±0.58	11.28±2.49	2.24±0.66
HCC组	0.90±0.22		6.95±1.29	16.61±3.45	6.66±1.25
t	22.392^＊＊		32.992^＊＊	15.345^＊＊	38.272^＊＊

病理特征	n	CD3⁺/%	CD4⁺/%	CD8⁺/%	CD4⁺/CD8⁺
肿瘤直径
<5 cm	43	56.41±5.00	32.77±4.41	37.14±3.71	0.88±0.22
5~10 cm	71	57.31±5.52	32.78±4.40	36.93±4.41	0.91±0.21
>10 cm	36	56.65±4.03	31.00±5.28	37.88±3.71	0.91±0.22
F		0.475	2.023	0.672	0.238
肿瘤数量
1~2枚	67	56.79±4.24	31.71±4.38	37.12±4.03	0.89±0.23
≥3枚	83	56.98±5.62	32.86±4.84	37.30±4.09	0.91±0.20
t		0.226	1.507	0.263	0.536
门脉癌栓情况
有	64	57.53±5.21	32.29±4.61	37.20±4.38	0.88±0.21
无	86	56.42±4.88	32.39±4.73	37.23±3.81	0.92±0.21
t		1.344	0.123	0.044	1.128
肝外转移
有	70	56.84±4.85	32.65±4.44	36.83±4.07	0.90±0.21
无	80	56.86±5.24	32.06±4.86	37.57±4.02	0.90±0.22
t		0.021	0.776	1.121	0.003
微血管侵犯
M0	59	57.81±5.59	32.06±4.66	37.60±4.16	0.90±0.23
M1	43	56.07±4.52	32.48±4.58	37.69±4.03	0.92±0.18
M2	48	56.51±4.66	32.59±4.81	36.32±3.87	0.89±0.23
F		1.713	0.189	1.756	0.170
淋巴结转移
有	66	55.89±4.64	31.33±4.56	38.05±3.80	0.84±0.21
无	84	57.68±5.22	33.15±4.61	36.56±4.15	0.95±0.21
t		2.197^＊	2.402^＊	2.266^＊	3.040^＊
肿瘤分化程度
Ⅰ级	47	57.48±5.46	32.78±4.26	36.77±3.97	0.91±0.17
Ⅱ级	38	56.41±4.57	32.80±4.70	37.98±3.94	0.93±0.22
Ⅲ级	42	57.05±5.25	31.95±4.42	37.46±3.96	0.87±0.23
Ⅳ级	23	56.18±4.61	31.43±5.53	36.41±4.54	0.89±0.27
F		0.495	0.645	0.999	0.460
HCC分期
Ⅰ期	51	56.68±4.78	31.72±5.48	37.05±3.80	0.89±0.21
Ⅱ期	58	56.55±5.56	32.08±4.15	36.81±4.08	0.92±0.21
Ⅲa期	41	57.64±4.59	33.51±4.10	38.01±4.29	0.88±0.23
F		0.626	1.871	1.124	0.483

病理特征	n	CD3⁺/%	CD4⁺/%	CD8⁺/%	CD4⁺/CD8⁺
肿瘤直径
<5 cm	43	56.41±5.00	32.77±4.41	37.14±3.71	0.88±0.22
5~10 cm	71	57.31±5.52	32.78±4.40	36.93±4.41	0.91±0.21
>10 cm	36	56.65±4.03	31.00±5.28	37.88±3.71	0.91±0.22
F		0.475	2.023	0.672	0.238
肿瘤数量
1~2枚	67	56.79±4.24	31.71±4.38	37.12±4.03	0.89±0.23
≥3枚	83	56.98±5.62	32.86±4.84	37.30±4.09	0.91±0.20
t		0.226	1.507	0.263	0.536
门脉癌栓情况
有	64	57.53±5.21	32.29±4.61	37.20±4.38	0.88±0.21
无	86	56.42±4.88	32.39±4.73	37.23±3.81	0.92±0.21
t		1.344	0.123	0.044	1.128
肝外转移
有	70	56.84±4.85	32.65±4.44	36.83±4.07	0.90±0.21
无	80	56.86±5.24	32.06±4.86	37.57±4.02	0.90±0.22
t		0.021	0.776	1.121	0.003
微血管侵犯
M0	59	57.81±5.59	32.06±4.66	37.60±4.16	0.90±0.23
M1	43	56.07±4.52	32.48±4.58	37.69±4.03	0.92±0.18
M2	48	56.51±4.66	32.59±4.81	36.32±3.87	0.89±0.23
F		1.713	0.189	1.756	0.170
淋巴结转移
有	66	55.89±4.64	31.33±4.56	38.05±3.80	0.84±0.21
无	84	57.68±5.22	33.15±4.61	36.56±4.15	0.95±0.21
t		2.197^＊	2.402^＊	2.266^＊	3.040^＊
肿瘤分化程度
Ⅰ级	47	57.48±5.46	32.78±4.26	36.77±3.97	0.91±0.17
Ⅱ级	38	56.41±4.57	32.80±4.70	37.98±3.94	0.93±0.22
Ⅲ级	42	57.05±5.25	31.95±4.42	37.46±3.96	0.87±0.23
Ⅳ级	23	56.18±4.61	31.43±5.53	36.41±4.54	0.89±0.27
F		0.495	0.645	0.999	0.460
HCC分期
Ⅰ期	51	56.68±4.78	31.72±5.48	37.05±3.80	0.89±0.21
Ⅱ期	58	56.55±5.56	32.08±4.15	36.81±4.08	0.92±0.21
Ⅲa期	41	57.64±4.59	33.51±4.10	38.01±4.29	0.88±0.23
F		0.626	1.871	1.124	0.483

病理特征	n	IgA/（g/L）	IgG/（g/L）	IgM/（g/L）
肿瘤直径
<5 cm	43	7.11±1.08	16.55±2.84	6.36±1.36
5~10 cm	71	6.76±1.40	16.52±3.69	6.80±1.23
>10 cm	36	7.13±1.27	16.87±3.69	6.74±1.10
F		1.447	0.135	1.746
肿瘤数量
1~2枚	67	6.90±1.30	17.00±3.23	6.85±1.21
≥3枚	83	6.99±1.28	16.30±3.61	6.51±1.27
t		0.447	1.229	1.668
门脉癌栓情况
有	64	6.87±1.39	16.23±3.31	6.61±1.37
无	86	7.01±1.21	16.89±3.54	6.70±1.16
t		0.683	1.162	0.393
肝外转移
有	70	6.97±1.33	16.56±3.22	6.52±1.31
无	80	6.99±1.23	16.63±3.66	6.78±1.19
t		0.093	0.124	1.302
微血管侵犯
M0	59	6.89±1.39	16.76±3.15	6.55±1.20
M1	43	6.92±1.42	16.24±3.86	6.88±1.25
M2	48	7.06±1.03	16.77±3.46	6.60±1.31
F		0.170	0.243	0.348
淋巴结转移
有	66	7.28±1.21	17.40±3.53	6.91±1.30
无	84	6.70±1.30	15.99±3.27	6.46±1.18
t		2.806^＊＊	2.527^＊	2.237^＊
肿瘤分化程度
Ⅰ级	47	6.92±1.32	16.48±3.63	6.68±1.21
Ⅱ级	38	7.00±1.22	16.23±3.43	6.71±1.39
Ⅲ级	42	6.90±1.35	16.64±3.31	6.70±1.06
Ⅳ级	23	7.03±1.29	17.46±3.44	6.45±1.46
F		0.074	0.635	0.258
HCC分期
I期	51	7.09±1.24	16.66±3.1	6.62±1.14
Ⅱ期	58	6.84±.1.18	16.37±3.46	6.71±1.29
Ⅲa期	41	6.94±1.49	16.89±3.86	6.63±1.34
F		0.521	0.276	0.081

原发性肝癌患者术前免疫因素及与病理特征的关系

Preoperative immune factors in patients with primary hepatocellular carcinoma and their relationship with pathological characteristics

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变量	AUC	95%CI	敏感度/%	特异度/%	截断值
CD3⁺	0.810	0.740~0.879	83.33	67.86	56.12%
CD4⁺	0.741	0.663~0.820	75.76	64.29	32.28%
CD8⁺	0.770	0.683~0.857	74.24	82.14	37.19%
CD4⁺/CD8⁺	0.707	0.625~0.789	87.88	50.00	0.86
IgA	0.756	0.675~0.837	54.55	91.67	6.59 g/L
IgG	0.738	0.658~0.819	69.70	69.05	17.17 g/L
IgM	0.727	0.644~0.810	68.18	69.05	7.34 g/L

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