目的：观察体外扩增的不成熟树突状细胞（dendritic cells, DC）胸腔内注射对恶性胸腔积液的疗效和安全性。方法：从6例对化疗耐药的恶性胸腔积液患者采集外周血单个核细胞，体外细胞因子诱导培养获得不成熟DC，每4周患者胸腔内注射DC( 5～10)×107个, 连续3次为一疗程, 观察治疗后患者胸腔积液的变化及治疗的不良反应，流式细胞仪检测胸水中T 细胞、NK细胞亚群。结果：总体疗效为: CR 2例, PR 1例, SD 1例, PD 2例, 有效率为50% (3/6) , 获益率( CR+PR+SD)为66.7%。2例CR均为肾癌患者，缓解时间达26周和147周；3例肺癌患者中1例PR、1例SD及1例PD；1例恶性胸膜间皮瘤PD；治疗中无严重不良反应发生。DC治疗后6例患者胸水中的T细胞百分率均较治疗前上升，但差异无统计学意义；NK细胞百分率较治疗前明显上升（P＜0.05）。结论：采用无抗原加载的自体不成熟DC胸腔内注射治疗恶性胸腔积液的疗效肯定，可能主要是通过NK细胞介导，是一种安全、有效的治疗方法。

Objective: To evaluate the effect and safety of intrapleural injection of in vitro expanded immature dendritic cells (DC) for the treatment of malignant pleural effusion. Methods: Peripheral blood mononuclear cells were collected from 6 patients with chemo-resistant malignant pleural effusion and cultured with cytokines to expand immature DC in vitro . The cells were then intrapleurally injected into the patients (5~10)×107 every 4 weeks for 3 times as a course of treatment. The changes of pleural effusion and side effects in each patient were examined. T cell and NK cell subsets in the pleural effusion were analyzed by flow cytometry. Results: Overall, 2 renal cell carcinoma patients had complete responses, 1 lung cancer patients had partial response, 1 lung cancer patients had SD, and 2 other patients had PD. Therefore, the response rate was 50% (3/6) and the benefit rate was 66.7%. Duration of the response of the 2 renal cell carcinoma patients was 26 weeks and 147 weeks respectively. After DC treatment, the percentages of T and NK cells increased in the pleural effusion, but only the increase of NK cells is statistically significant. Conclusion: This pilot study indicated that intrapleural injection of none-antigen loaded immature DCs is well-tolerated, has positive effect on the management of malignant pleural effusions, which is likely mediated by NK cells. These results suggest that DC immunotherapy is a promising method to treat malignant pleural effusions in the future.

江苏省“六大人才高峰” 资助项目（No.2010-WS-012）。