目的 探讨局部晚期直肠腺癌腔内近距离放射治疗对患者的免疫功能和营养指标的影响。 方法 纳入 2016 年 5 月 至 2024 年 7 月武汉大学中南医院肿瘤科收治的 89 例局部晚期直肠腺癌患者。 根据治疗方式分为研究组(腔内近距离放射治 疗联合新辅助放化疗,33 例)和对照组(新辅助放化疗,56 例)。 收集治疗前 1 周和放射治疗(简称放疗)结束后 1 个月的外周 血淋巴细胞及其亚群计数、白蛋白和总蛋白水平。 比较不同治疗方式对营养指标(白蛋白和总蛋白)和免疫功能(淋巴细胞及 其亚群)的影响。 采用多元线性回归分析放疗结束后 1 个月淋巴细胞及其亚群的影响因素。 结果 研究组和对照组在治疗前 1 周、放疗结束后 1 个月白蛋白和总蛋白水平差异无统计学意义。 放疗结束后 1 个月研究组淋巴细胞、CD8 + T 细胞计数均高 于对照组。 同样,病理完全缓解(pCR)患者放疗结束后 1 个月淋巴细胞、CD8 + T 细胞绝对值计数高于非 pCR 患者。 不同治疗 方式是放疗结束后 1 个月淋巴细胞、CD8 + T 细胞计数的独立影响因素。 结论 与新辅助放化疗相比,联合腔内近距离放射治疗 更有利于增加放疗结束后 1 个月淋巴细胞、CD8 + T 细胞数量,改善免疫功能同时不增加局部晚期直肠腺癌患者营养不良的 风险。

Objective This study aimed to investigate the influence of intracavitary brachytherapy on immune function and nutritional indicators in patients with rectal adenocarcinoma. Method A total of 89 patients with locally advanced rectal adenocarcinoma admitted to the Oncology Department of Zhongnan Hospital of Wuhan University from May 2016 to July 2024 were included. According to the treatment regimens they were divided into the study group neoadjuvant chemoradiotherapy combined intracavitary brachytherapy n = 33 patients and the control group neoadjuvant chemoradiotherapy n = 56 patients . Peripheral blood absolute lymphocyte counts ALC and their subsets albumin and total protein levels 1 week before treatment and 1 month after the end of radiotherapy were obtained. The effects of different treatment groups on immune function lymphocytes and their subsets and nutritional indicators albumin and total protein levels were compared. Multiple linear regression was used to analyze the influencing factors of lymphocytes and their subsets 1 month after radiotherapy. Result There was no significant difference in albumin and total protein levels between the study group and control group 1 week before treatment and 1 month after the end of radiotherapy. At 1 month after the end of radiotherapy the study group had higher levels of ALC and CD8 + T cells than the control group. Similarly patients with pathologic complete response pCR showed higher levels of ALC and CD8 + T cells than patients with non-pCR. Different treatment groups were identified as independent influencing factors for ALC and CD8 + T cells 1 month after the end of radiotherapy. Conclusion Compared to the neoadjuvant chemoradiotherapy group intracavitary brachytherapy combined with neoadjuvant chemoradiotherapy can increase the number of lymphocytes and CD8 + T cells 1 month after radiotherapy improve immune function and do not increase the risk of malnutrition in rectal adenocarcinoma patients.