观察高剂量少分次放疗治疗胰腺癌前后，免疫功能、营养及体力状态的变化。

前瞻性收集空军特色医学中心拟行胰腺癌放疗患者，采用螺旋断层放疗系统治疗，胰腺病灶PTV、CTV、GTV分别为70 Gy、60 Gy、50 Gy，15或20次，治疗前和治疗结束后均接受检测血液淋巴细胞百分比、体液免疫指标（IgG、IgA、IgM、C₃、C₄）、细胞免疫指标（CD₃、CD₄、CD₈）及血液营养相关指标（血红蛋白、白蛋白、白球比），并评价体力状态（KPS），采用配对t检验比较治疗前后参数值差异。

共入组34例，患者治疗前血液淋巴细胞比率低于正常值的例数为8（23.5%）例，疗后34（100%）例。治疗前体液免疫参数IgG、IgA、IgM、C₃及C₄值低于正常值的例数分别为0、0、2（5.9%）、7（20.6%）、1（2.9%）例，治疗后IgG、IgA、IgM、C₃及C₄值低于正常值的例数分别为1（2.9%）、0、7（20.6%）、6（17.6%）、0例。治疗前细胞免疫指标CD₃、CD₄百分比值低于正常值的例数均为1（2.9%）例，CD₈高于正常值的例数为2例（5.9%），治疗后细胞免疫指标各参数例数不变。淋巴细胞比率平均降低63.0±20.6%（P＜0.001），IgM值平均降低9.6±17.5%（P=0.011），其余免疫参数治疗前后均无统计学差异（P＞0.05）。治疗前营养状态指标血红蛋白、白蛋白及白球比低于正常值的例数分别为7（20.6%）、4（11.8%）、0（0）例，治疗后分别为8（23.5%）、4（11.8%）、0（0）例，治疗前后均无统计学差异。KPS评分疗后较前改善占44.1%（15例），稳定占44.1%（15例）。

胰腺癌高剂量少分次放疗对患者的免疫功能有一定影响，对营养及体力影响小。

To observe the changes of immune function, nutritional status, and performance status in patients after high-dose hypofractionated radiotherapy for pancreatic cancer.

We prospectively collected patients with pancreatic cancer who would undergo radiotherapy with helical tomotherapy at our hospital. A total dose of 50/60/70 Gy in 15 or 20 fractions was delivered to the PTV, CTV, and GTV, respectively. Lymphocyte percentage, humoral immunity indexes (IgG, IgA, IgM, C₃, and C₄), cellular immunity indexes (CD₃⁺, CD₄⁺, and CD₈⁺ T cells), nutrition related indexes (hemoglobin, albumin, and albumin to globulin ratio), and physical status (KPS) were evaluated before and after radiotherapy. The paired t-test was used to compare the difference in the immune indicators before and after treatment.

A total of 34 patients were enrolled in the study. The number of patients with a lower lymphocyte percentage than normal was 8 (23.5%) before treatment and 34 (100%) after treatment. The numbers of patients with lower IgG, IgA, IgM, C₃, and C₄ were 0, 0, 2 (5.9%), 7 (20.6%), and 1 (2.9%), respectively, before treatment; the corresponding numbers after treatment were 1 (2.9%), 0, 7 (20.6%), 6 (17.6%), and 0. The numbers of patients a lower CD₃⁺ T cell percentage, lower CD4⁺ T cell percentage, and higher CD₈⁺ T cell percentage were 1 (2.9%), 1 (2.9%), and 2 (5.9%), respectively, both before and after treatment. The lymphocyte percentage was decreased by 63.0±20.6% (P＜0.001) and IgM was decreased by 9.6±17.5% on average (P=0.011); the other parameters had no statistical difference before and after treatment. Before treatment, the numbers of cases with lower hemoglobin, albumin, and albumin to globulin ratio were 7 (20.6%), 4 (11.8%), and 0 (0) before treatment and 8 (23.5%), 4 (11.8%), and 0 (0) after treatment, respectively; there was no statistical difference in these paramters before and after treatment. After treatment, the KPS score was improved in 44.1% (15 cases) and stable in 44.1% (15 cases).

High-dose hypofractionated radiotherapy for pancreatic cancer has appreciated effect on the immune function of patients, but has little effect on the nutritional and performance status of patients.