脳腫瘍のimmunological monitoring—脳腫瘍患者の予後と細胞性免疫能

IMMUNOLOGICAL MONITORING OF BRAIN TUMORS:PREDICTION OF PROGNOSIS OF BRAIN TUMOR PATIENTS

　抄録　脳腫瘍において，細胞性免疫が，その増大や再燃に何らかの関係をもつであろうことは想像に難くない。そして細胞性免疫能のモニターには各種の皮内反応が用いられている。そのためわれわれはPPD（purified protein derivative）とPHA （phytohemagglutinin）を用い，22例のグリオーマおよび9例の転移性脳腫瘍につき検討した。この結果，良性グリオーマ11例中8例で皮内反応は陽性であり，悪性グリオーマは11例中　PPD 3例，　PHA 4例のみが陽性となった。また，皮内反応陽性の場合，その生命予後は比較的良く，臨床症状が重篤で，予後不良のものは皮内反応は陰性であった。更に，PHA皮内反応は，各種の治療に伴う臨床症状の改善と一致して陽性となり，逆に脳腫瘍の増大，進展による症状増悪に一致して陰性となり，免疫能モニターとしては，PPD皮内反応と比べ，より有用であった。

The usefulness of in vivo skin tests for reaction to purified protein derivative (PPD) and phytohe-magglutinin (PHA) for assessment of cell media-ted immunity was investigated among 31 patients with brain tumors. These included 22 gliomas and 9 metastatic brain tumors.

Each patient was administered intradermal injec-tions of 0.05 μg PPD and 0.5 μg PHA, and ery-thema was observed in each case.

A positive reaction (erythema diameter greater than 10 mm) to PPD was observed in 8 (74%) of 11 low grade gliomas, 3 (27%) of 11 malignant gliomas and 6 (67%) of 9 metastatic brain tumors.

A positive reaction (erythema diameter greater than 25 mm) to PHA was observed in 8 (74%) of 11 low grade gliomas, 4 (36%) of 11 malignant gliomas, and 6 (67%) of 9 metastatic brain tumors.

In repeated PHA skin reaction tests conducted at intervals of one month, the reaction of the patients depended on their clinical state.

Thirteen of the patients died. The PHA skin reaction of 7 of the 13 patients who survived for more than 6 months was all negative 6 months prior to death, and continued and repeated reaction tests did not result in a positive finding except for one patient with malignant glioma. In 10 ofthe 13, the PHA skin reaction was negative one month prior to death, and the final test result was negative for 11 of the 13.

Repeated PPD skin reaction tests of the 7 of the 13 patients who survived for more than 6 months showed positive for 3 and remained positive for one until death. One month prior to death, PPD skin reaction was negative for only 5 of the 13 patients.

PPD and PHA skin reaction tests are useful and simple ways of examining the cellular immunity of brain tumor patients and thereby determining the histological malignancy of the glioma.

The PHA skin reaction test is more useful than the PPD skin reaction test in predicting the prognosis of brain tumor patients.