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악성종양환자의 호중구기능에 관한 연구

Title
악성종양환자의 호중구기능에 관한 연구
Authors
이순남
Issue Date
1986
Department/Major
대학원 의학과
Publisher
이화여자대학교 대학원
Degree
Doctor
Abstract
악성종양환자에서 감염은 그 발생빈도나 중증도가 건강인에 비하여 훨씬 높으며 이는 악성종양환자의 면역기능의 감소에 의한다. 즉 탐식작용의 감소, 혈장 opsonin의 결여, 호중구나 단핵구의 기능감소 등으로 방어기전이 장애되거나 치료에 의한 이차적인 방어기전의 손상 때문이다. 저자는 급성골수성백혈병 15예, 임파종 10예, 위암 40예, 간암 10예, 췌장암 10예, 기타장기암 25예 등 총 110예에서 감염방생 기전의 일부분으로 추정되는 호중구의 기능변화를 밝히고자 호중구의 종합적인 기능검사를 시행하여 다음과 같은 결론을 얻었다. 1. 호중구의 부착능은 급성골수성백혈병환자에서 통계학적으로 유의하게 감소되었고 임파종환자에서는 통계학적으로 유의하게 증가되었으나, 다른 고형암에서는 통계학적으로 유의성이 없었고 10예의 위암환자에서는 Cisplatin과 5-FU를 투여한 후 통계학적으로 유의하게 감소되었다. 2. 화학주성변수는 급성골수성백혈병환자에서는 대조군에 비해 통계학적으로 유의하게 감소되었으나 간, 췌장암환자에서는 증가되었고 다른 고형암에서는 대조군과 비슷하였다. 10예 의 위암환자에서 Cisplatin 투여후에 통계학적으로 유의한 감소가 있었으나 5-FU 투여후에는 통계학적으로 유의한 차이가 없었다. 3. NBT 환원은 대조군에 비해 급성골수성백혈병환자에서 통계학적으로 유의하게 감소되었으나 임파종, 위암, 기타장기암에서는 통계학적으로 유의하게 감소되었으나 임파종, 위암, 기타장기암에서는 통계학적으로 유의한 차이가 없었고, 간, 췌장암에서는 유의하게 증가되었다. NBT 환원 역시 Cisplatin 투여 후 통계학적으로 유의하게 감소되었으며 5-FU 투여 후에도 감소되었으나 통계학적 유의성은 없었다. 이상의 결과로 악성종양환자중 급성골수성백혈병환자에서는 호중구의 기능이 현저히 저하되었으나 간암 및 췌장암에서는 화학주성과 NBT 환원이 증가되었고 고형암에서는 호중구 자체의 기능은 크게 손상을 받지 않았으나 Cisplatin과 5-FU 투여에 의해 그 기능이 저하됨을 알 수 있었으며 고형암환자에서 화학요법에 의한 호중구의 기능감소는 감염의 감수성을 증가시키는 요인이 될 것으로 생각된다. ; It has been recognize for a long time that human malignant diseases are associated with immune dificiency states. Impaired phagocytic function, low levels of plasma opsonins, impaired bactericidal activity of granulocytes and macrophages, deficiency of myeloperoxydase, reduced migration of polymorphonuclear leukocytes and granulocytopenia have all been found in malignant condition primarily or secondarily. Especially neutrophils are crucial to the body’s defenses against infection. Defects in phagocytes can contribute to the local establishment and systemic spread of serious bacterial infection. The author studied neutrophil function in 40 control and 15 patients with acute myelogenous leukemia, 10 with non-Hodgkin’s lymphoma, 40 with stomach cancer, 10 with hepatoma, 10 with pancreas cancer and 25 with other organ tumor to prove the mechanism of increased risk and the severity of infection using a battery of simple and reproducible neutrophil function tests as adherence to nylon wool fiber, migration under agarose method and nitroblue tetrazolium reduction test. The results obtained are as follows; 1. On adherence to nylon wool fiber, the adherence was significantly decreased in patients with acute myelogenous leukemia, but increased in patients with lymphoma. In patients with other solid tumors, there were no significant differences from those of controls. After chemotherapy with Cisplatin and 5-FU, the adherence was significantly decreased than that of prior to therapy. 2. On migration under agarose, the chemotactic differential was significantly decreased in patients with acute myelogenous leukemia but increased in patients with acute myelogenous leukemia but increased in patients with acute myelogenous leukemia but increased in patients with hepatoma and pancreas cancer. Presence of factors of those increment was suspected. After infusion of Cisplatin, chemotactic differential was decreased significantly but after infusion of 5-FU, it was decreased but there was no significance. 3. On NBT reduction test, NBT reduction was diminished in patients with acute myelogenous leukemia but increased in patients with hepatoma and pancreas cancer. It is assumed that some unidentified factors would be present to enhance chemotaxis and NBT reduction in patients with hepatoma and pancreas cancer. After infusion of Cisplatin, NBT reduction was significantly decreased, but after infusion of 5-FU it was decreased but not significantly. In patients with acute myelogenous leukemia, neutrophil functions were much impaired but in patients with solid tumors, there were no neutrophil function defects. After chemotherapy with Cisplatin and 5-FU neutrophil functions were much compromised and this would predispose to increased risk of infection.
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