Haffejee A A, Angorn I B
Ann Surg. 1979 Apr;189(4):475-9.
In carcinoma of the esophagus, two major factors are operative, both of which are capable of suppressing the immune response, namely starvation and the presence of a malignant tumor. Twenty patients who were treated by palliative intubation for unresectable carcinoma of the esophagus were investigated. All patients were suffering from protein-calorie malnutrition and were shown to be in negative nitrogen balance. Lymphocyte counts and the nonspecific cellular and humoral immune response were evaluated before and after correction of the nutritional deficit. No attempt was made to reduce tumor bulk. The cellular immune response was compromised in all patients. The DNCB skin test was negative, absolute lymphocyte counts and T-lymphocyte numbers were significantly depressed, and the mitogenic response to phytohaemagglutinin (PHA) stimulation also significantly depressed. Immunoglobulin A levels were significantly elevated but serum complement concentrations were normal. Reversal of the negative nitrogen balance resulted in a significant increase in absolute and T-lymphocyte numbers, and a significant increase in the mitogenic response to PHA. The DNCB skin test, however, remained nonreactive. Nutritional repletion also significantly increased serum C(3), C(4) and C(3)PA concentrations. Reversal of negative nitrogen balance may reverse in vitro evidence of immunoparesis and produce an increase in complement concentrations, without therapeutic reduction in the tumor load.
在食管癌中，有两个主要因素起作用，这两个因素都能够抑制免疫反应，即饥饿和恶性肿瘤的存在。对20例因不可切除的食管癌而接受姑息性插管治疗的患者进行了调查。所有患者均患有蛋白质-热量营养不良，且均处于负氮平衡状态。在纠正营养缺乏之前和之后，对淋巴细胞计数以及非特异性细胞免疫和体液免疫反应进行了评估。未尝试减少肿瘤体积。所有患者的细胞免疫反应均受到损害。二硝基氯苯（DNCB）皮肤试验呈阴性，绝对淋巴细胞计数和T淋巴细胞数量显著降低，对植物血凝素（PHA）刺激的促有丝分裂反应也显著降低。免疫球蛋白A水平显著升高，但血清补体浓度正常。负氮平衡的逆转导致绝对淋巴细胞和T淋巴细胞数量显著增加，对PHA的促有丝分裂反应也显著增加。然而，DNCB皮肤试验仍无反应。营养补充也显著提高了血清C3、C4和C3PA浓度。负氮平衡的逆转可能会逆转免疫麻痹的体外证据，并使补体浓度升高，而无需对肿瘤负荷进行治疗性降低。
