NLR、PLR、LMR与乳腺癌新辅助化疗疗效及预后的关系研究

摘要 目的：探讨化疗前外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）与乳腺癌患者新辅助化疗疗效及预后的关系。方法：选择2016年10月至2018年1月在安徽医科大学附属安庆第一人民医院进行新辅助化疗的乳腺癌患者105例为研究对象,根据新辅助化疗疗效分为病理完全缓解（pCR）组（26例）和非pCR组（79例）。比较pCR组和非pCR组化疗前外周血NLR、PLR、LMR;采用受试者工作特征（ROC）曲线分析化疗前外周血NLR、PLR、LMR对乳腺癌患者新辅助化疗病理疗效预测价值。所有患者术后随访5年,根据ROC曲线确定的NLR、PLR、LMR最佳截断值分为高NLR、PLR、LMR组和低NLR、PLR、LMR组,采用K-M生存曲线分析不同NLR、PLR、LMR组5年无病生存期（DFS）;单因素和多因素COX回归分析预后不良的影响因素。结果：pCR组化疗前NLR、PLR均低于非pCR组（P＜0.05）,LMR高于非pCR组（P＜0.05）。化疗前NLR、PLR、LMR三项联合预测新辅助化疗病理疗效的曲线下面积（AUC）均大于各指标单独预测。K-M生存曲线分析显示,化疗前高NLR、PLR组5年DFS分别低于低NLR、PLR组（P＜0.05）,高LMR组5年DFS高于低LMR组（P＜0.05）;多因素COX回归分析显示,NLR、PLR升高是乳腺癌预后的危险因素,LMR升高是保护因素（P<0.05）。结论：pCR组化疗前NLR、PLR更低,LMR更高,高NLR、PLR和低LMR患者5年DFS更低。NLR、PLR、LMR对新辅助化疗病理疗效具有一定的预测价值,三项联合能为乳腺癌的新辅助化疗评估提供重要参考依据。     

外周血中常见血液学参数对乳腺癌预后评估价值的研究进展

在世界范围内,乳腺癌是最常见的女性恶性肿瘤,严重危害人民健康。最近的流行病学和临床研究发现炎性反应与乳腺肿瘤有着一定的联系。炎症构成肿瘤微环境的一部分,炎性细胞的变化影响着肿瘤的进展,包括乳腺癌细胞增殖,侵袭,免疫力降低,转移等。检验外周静脉血中的白细胞、中性粒细胞、淋巴细胞、单核细胞、血小板以及衍生出的中性粒细胞/淋巴细胞比值(NLR)、派生中性粒细胞/淋巴细胞(d-NLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)等可以反映许多恶性肿瘤细胞的炎性状态。深入研究外周血中常见的标记物与乳腺癌的治疗及预后的关系,为临床医师提供有价值的参考信息,将具有重要的临床意义和应用前景。本文就外周血中常见的标记物进行相关论述,以期为乳腺癌的治疗及预后提供一个新的方法。     

Partial restoration of T‐cell function in aged mice by in vitro blockade of the PD‐1/ PD‐L1 pathway

Programmed cell death‐1 (PD‐1) is a newly characterized negative regulator of immune responses. The interaction of PD‐1 with its ligands (PD‐L1 and PD‐L2) inhibits T‐cell proliferation and cytokine production in young mice. Increased PD‐1 expression has been described during chronic infections, inducing chronic activation of the immune system to control it. As aging is associated with chronic immune activation, PD‐1 may contribute to age‐associated T‐cell dysfunction. Our data showed the following results in aged mice: (i) the number of PD‐1‐expressing T cells and the level of expression of PD‐Ls was increased on dendritic cell subsets and T cells; (ii) PD‐1⁺ T cells were exhausted effector memory T cells, as shown by their lower level of CD127, CD25 and CD28, as well as their limited proliferative and cytokine‐producing capacity; (iii) the expression of PD‐1 was up‐regulated after T‐cell receptor‐mediated activation of CD8⁺ T cells, but not of CD4⁺ T cells; (iv) blockade of the PD‐1/PD‐L1 pathway moderately improved the cytokine production of T cells from old mice but did not restore their proliferation; and (v) blockade of the PD‐1/PD‐L1 pathway did not restore function of PD‐1⁺ T cells; its effect appeared to be exclusively mediated by increased functionality of the PD‐1^? T cells. Our data thus suggest that blockade of the PD‐1/PD‐L1 is not likely to be efficient at restoring exhausted T‐cell responses in aged hosts, although improving the responses of PD‐1^? T cells may prove to be a helpful strategy in enhancing primary responses.     

The effect of soluble LAG-3 (CD223) treatment in fetal thymic organ culture

Lymphocyte activation gene-3 (LAG-3; CD223) is structurally similar to CD4 and binds to MHC class II with a 100-fold higher affinity than that of CD4. Soluble LAG-3 (sLAG-3Ig) might be useful for immunotherapy by inducing MHC class II-mediated cell activation. A new form of sLAG-3Ig was constructed containing a critical binding site (D1 and D2 region) to MHC class II, combined with a Fc portion of an immunoglobulin gamma1. After treatment of sLAG-3Ig in fetal thymic organ culture from DO11.10 transgenic mouse, CD4(+) T cell precursors were increased in the positive selection but not affected in the negative selection. Further analysis by treating sLAG-3Ig on thymic epithelial cells revealed that CD40 and MHC class II were up-regulated. These results may demonstrate that the treatment of sLAG-3Ig increases the precursor frequency of CD4(+) T cells by activation of thymic epithelial cells.     

Aged regulatory T cells protect from autoimmune inflammation despite reduced STAT3 activation and decreased constraint of IL-17 producing T cells

Regulatory T cells (Tregs) are specialized CD4⁺ T lymphocytes helping defend against autoimmunity and inflammation. Although age is associated with increased inflammation and autoimmunity, few reports address age effects of immune regulation or auto‐aggressive T cells. We show here that young and aged naïve CD4⁺ T cells are equivalently auto‐aggressive in vivo in T cell‐driven autoimmune colitis. Young and aged CD4⁺ Tregs equally suppressed age‐matched T cell proliferation in vitro and controlled clinical and pathologic T cell‐driven autoimmune colitis, suggesting equivalent regulatory function. However, whereas young and aged CD4⁺ Tregs suppressed interferon (IFN)‐γ⁺ T cells equivalently in this model, aged CD4⁺ Tregs unexpectedly failed to restrain interleukin (IL)‐17⁺ T cells. Nonetheless, young and aged CD4⁺ Tregs equally restrained IL‐17⁺ T cells in vivo during acute inflammation, suggesting a chronic inflammation‐related defect in aged CD4⁺ Tregs. In support, aged Tregs expressed reduced STAT3 activation, a defect associated with poor IL‐17‐producing T cell restraint. Aged naïve mice had markedly increased programmed death (PD)‐1⁺ T cells, but these exhibited no significant auto‐aggressive or regulatory functions in T cell‐driven colitis. Young CD8⁺ CD122^? T cells induce autoimmune bone marrow failure, but we show that aged CD8⁺ CD122^? T cells do not. These data demonstrate no apparent age‐related increase in auto‐aggressive T cell behavior, but disclose previously unrecognized functional defects in aged CD4⁺ Tregs during chronic inflammation. IL‐17 can be inflammatory and contributes to certain autoimmune disorders. Reduced aged Treg function during chronic inflammation and reduced IL‐17 restraint could contribute to age‐related inflammation or autoimmunity.     

小鼠胸腺基质细胞系分泌的趋化因子的分析

利用Boyden小室法和FACS分析法,我们分析了五株小鼠胸腺基质细胞系(MTSC)培养上清液对中性粒细胞,单核巨噬细胞和淋巴细胞的化学趋化因子(Chemokines)活性,及定向迁移的淋巴细胞中B细胞、CD 4~ CD 8~-和CD4~-CD8~ T细胞的比例。结果显示,五株MTSC的培养上清液对上述靶细胞均有不同程度的趋化作用.MTSC细胞分泌趋化因子的情况可分为三类:1.MTEC 1和MTEC 2产生的Chemokine(s)对中性粒细胞和淋巴细胞的趋化作用相对较强;2.MTDC 4分泌的Chemokine(s)主要作用于单核巨噬细胞;3.MTEC 3和MTEC 5分泌的Chemokine(s)对多种类型的靶细胞,包括中性粒细胞、单核巨噬细胞和淋巴细胞,表现的趋化作用没有明显的强弱之分。MTSC-SN对B细胞的趋化活性普遍高于对T细胞的趋化活性,对CD 4~-CK 8~ T细胞的趋化活性高于对CD 4~ CD 8~-T细胞的趋化活性。MTSC-SN中趋化因子的分析,有利于新型chemokines的发现及其生物功能的阐明,并可进一步研究Chemok-ine(s)在T细胞发育中的作用。     

Thymic epithelial progenitor cells and thymus regeneration： an update

The thymus provides the essential microenvironment for T-cell development and maturation. Thymic epithelial cells （TECs）, which are composed of thymic cortical epithelial cells （cTECs） and thymic medullary epithelial cells （mTECs）, have been well documented to be critical for these tightly regulated processes. It has long been controversial whether the common progenitor cells of TECs could give rise to both cTECs and mTECs. Great progress has been made to characterize the common TEC progenitor cells in recent years. We herein discuss the sole origin paradigm with regard to TEC differentiation as well as these progenitor cells in thymus regeneration.