摘要
目的探讨燃煤型砷中毒患者免疫功能改变及其规律，为肿瘤风险评估提供依据。方法70例患者均系贵州省黔西南州燃煤型砷中毒高发区既往经临床及实验室确诊的燃煤型砷中毒病例，其中男性44例。女性26例．年龄24-71岁，平均年龄41岁。接病程及是否癌变分为4组：〈10年组，23例；10～19年组，21例；≥20年组，20例；癌变组（病程≥20年），6例。对照组为健康职工和大学生自愿者，26例。采静脉血，流式细胞仪分析各组人群外周血淋巴细胞亚群CD3^＋（总T细胞）、CD3^＋CD4^＋（诱导性／辅助性T细胞）、CD3^＋CD8^＋（抑制性／细胞毒性T细胞）、CD19^＋（B淋巴细胞）和CD56^＋CD16^＋（自然杀伤细胞，NK）细胞组成比例，并对淋巴细胞膜人类白细胞组织相容性抗原-DR（HLA—DR）、细胞表面抗原（CD）25和CD38分子表达率进行检测。结果〈10年组、10～19年组、≥20年组和癌变组人群外周血CD3^＋细胞百分率分别为（63．76±9．32）％、（55．63±12．97）％、（51．00±12．23）％、（49．83±9．89）％，均低于对照组[（68．10±8．62）％]，组间比较差异有统计学意义（F=12．862，P〈0．05）。CD3^＋CD4^＋细胞比例上述各组分别为（31．35±6．62）％、（28．38±8．66）％、（24．13±6．46）％、（19．17±4．96）％，明显低于对照组[（34．28±7．32）％]，组间比较差异有统计学意义（F=10．455，P〈0．05）。≥20年组和癌变组CD19^＋细胞百分率[（9．00±5．32）％、（9．00±3．29）％]低于对照组和〈10年组[（11．80±3．43）％、（12．35±4．53）％]，组间比较差异有统计学意义（P〈0．05）；其余各组之间两两比较差异均无统计学意义（P〉0．05）。癌变组淋巴细胞CD25和CD38表达率[（17．96±4．98）％、（41．38±8．54）％]明显高于对照组[（13．10±3．38）％、（28．60±5．51）％]，组间两两比较差异有统计学意义（P〈0．05）；HLA—DR表达率在10—19年组[（18．20±6．25）％]明显高于对照组[（10．72±7．06）％]和〈10年组[（11．78±5．13）％]，≥20年组[（20．30±8．01）％]与癌变组[（21．82±10．97）％]在同一水平。结论砷所致机体细胞免疫功能削弱可能是燃煤型砷中毒患者皮肤癌变的重要机制．细胞免疫功能状态可作为燃煤砷中毒患者皮肤癌变的预警信号。
Objective To study the change and rule of immunological function among the patients with coal arsenic poisoning in order to provide a basis for tumor risk evaluation and monitoring. Methods Seventy patients with coal arsenic poisoning aged from 24 to 71 years old （44 men, 26 women, averaging 41 years old） were divided into 4 groups including 23 cases having a course less than 10 years, 21 cases lasting for 10 - 19 years, 20 cases for more than 20 years, 6 cases of cancer, and 26 healthy normal controls. Flow cytometer（FCM） was used to analyze the frequency of CD3^＋（total T cell）, CD3^＋CD4^＋（inducer/helper T cell）, CD3^＋CD8^＋（suppressor/cytotoxie T cell）, CD19^＋（B lymphocyte）, and CD56^＋CD16^＋（natural killer cell）lymphocyte subsets in the peripheral blood of the subjects and the expression rates of lymphocytic membrane surface molecules of human leucocyte antigen （HLA）-DR, CD25, CD38 were also determined by FCM. Results The proportions of CD3^＋ cells in peripheral blood of less than 10 years, 10 - 19 years, more than 20 years and cancer groups were （63.76 ± 9.32）%, （55.63 ±12.97）%, （51.00 ± 12.23）% and （49.83 ± 9.89）% respectively, which were significantly lower than that in control group[ （68.10 ± 8.62）% ], and there was a significant difference between different groups （F = 12.862, P 〈 0.05）. In less than 10 years, 10 - 19 years, more than 20 years and cancer groups, the proportion of CD3^＋CD4^＋ cells was （31.35 ± 6.62）%, （28.38 ± 8.66）%, （24.13 ± 6.46）% and （19.17 ± 4.96）% respectively, which was significantly lower than that in control group[ （34.28 ± 7.32）%3, and significant intra-group difference was found （F = 10.455, P 〈 0.05）. The percentages of CD19^＋ cells in more than 20 years and cancer groups[ （9.00 ± 5.32）%, （9.00 ±3.29）%] were lower than that in control group and less than 10 years group[ （11.80 ± 3.43）%, （12.35 ± 4.53）%] （P 〈 0.05）, while no statistical difference was found between other groups. The expression rates of CD25 and CD38 in lymphocytes of cancer group[ （17.96 ± 4.98）%, （41.38 ± 8.54）%] were obviously higher than those in control group [ （ 13.10 ± 3.38）%, （28.60 ± 5.51 ）% ] and there were statistical differences between the experimental groups（P 〈 0.05 ）. The expression rate of HLA-DR in 10 -19 years groups [ （18.20 ±6.25 ）% ] was significantly higher than that in control group [ （10.72 ± 7.06）% ] and less than 10 years group [ （11.78 ±5.13）% ], while it was the same in more than 20 years and cancer group[ （20.30 ± 8.01 ）%, （21.82 ±10.97）% ]. Conclusions Reduction of cellular immune function caused by coal arsenic poisoning may be an important mechanism of skin cancer. Cellular immune function may be used as a warning signal of skin cancerization of patients with coal arsenic poisoning.
出处
《中国地方病学杂志》
CAS
CSCD
北大核心
2008年第5期561-565,共5页
Chinese Jouranl of Endemiology
关键词
煤
砷中毒
淋巴细胞亚群
免疫
细胞
癌变
Coal
Aarsenic poisoning
Lymphocyte subsets
Cellular immunity
Tumor
