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投稿时间：2021-12-30 网络发布日期：2022-06-20
投稿时间：2021-12-30 网络发布日期：2022-06-20
中文摘要: 目的 探讨宫颈癌放疗患者放疗前CD4+/CD8+、B淋巴细胞、抑制/细胞毒性T细胞联合预测放射性肠炎（RE）的价值。方法 回顾性分析2019年1月至2021年3月在中国科学院合肥肿瘤医院接受放疗的87例宫颈癌患者的临床资料，根据患者是否发生RE将患者分为RE组（n=27）和非RE组（n=60），并根据常见不良反应事件评价标准将RE组中≥2级者归为高症状级别组(HRE组，n=17)，1级者归为低症状级别组(LRE组，n=10)。比较患者放疗前血浆CD4+/CD8+、B淋巴细胞、抑制/细胞毒性T细胞，采用受试者工作特征（ROC）曲线分析放疗前CD4+/CD8+、B淋巴细胞、抑制/细胞毒性T细胞预测RE的价值。结果 放疗前RE组患者抑制/细胞毒性T细胞高于非RE组患者（35.04±2.39 vs 24.86±1.05），CD4+/CD8+（0.87±0.10 vs 1.88±0.13）、B淋巴细胞（6.60%±1.11% vs 10.45%±0.54%）低于非RE组患者，差异有统计学意义（P<0.01）。HRE组抑制/细胞毒性T细胞高于LRE组，CD4+/CD8+、B淋巴细胞低于LRE组，差异有统计学意义（P<0.05，P<0.01）。CD4+/CD8+、B淋巴细胞、抑制/细胞毒性T细胞值预测RE的截断值分别为1.15、4.95%、26.85。CD4+/CD8+预测RE的AUC为0.798（95%CI：0.733～0.901）；B淋巴细胞预测RE的AUC为0.74（95%CI：0.634～0.828）；抑制/细胞毒性T细胞预测RE的AUC为0.762（95%CI：0.658～0.847）；三者联合预测RE的AUC为0.901（95%CI：0.795～0.941）；联合检测时AUC分别明显高于三者单独检测，差异均有统计学意义（P<0.05）。结论 宫颈癌患者CD4+/CD8+、B淋巴细胞、抑制/细胞毒性T细胞与RE发生率密切相关，CD4+/CD8+越低，B淋巴细胞下降越明显，抑制/细胞毒性T细胞增加越高预示着细胞免疫功能失衡越严重，RE发生的概率越高。
Abstract:Objective To investigate the value of CD4+/CD8+, B lymphocytes, suppressor/cytotoxic T cell in predicting radiation enteritis (RE) in patients with cervical cancer received radiotherapy. Methods A retrospective analysis was performed on the clinical data of 87 patients with cervical cancer undergoing radiotherapy in Hefei Cancer Hospital from January 2019 to March 2021. The patients were divided into RE group (n=27) and non-RE group (n=60) according to whether RE occurred during radiotherapy. By Common Terminology Criteria for Adverse Events (CTCAE), the patients in RE group were subdivided into high RE group (HRE group, ≥grade 2, n=17) and low RE group (LRE group, grade 1, n=10). The levels of CD4+/CD8+, B lymphocytes and suppressor/cytotoxic T cells in plasma were detected and compared to analyze their value in predicting RE by drawing receiver operating characteristic (ROC) curve. Results Before radiotherapy, the suppressor/cytotoxic T cells （35.4±2.39 vs 24.86±1.05） in RE group were significantly higher than those in non-RE group, and CD4+/CD8+ （0.87±0.10 vs 1.88±0.13） and B lymphocytes （6.60%±1.11% vs 10.45%±0.54%） were lower than those in non-RE group (P<0.01). The suppressor/cytotoxic T cells in HRE group were statistically higher than those in LRE group, and CD4+/CD8+ and B lymphocytes were significantly lower than those in LRE group (P<0.05, P<0.01). The cut-off values of CD4+/CD8+, B lymphocyte and suppressor/cytotoxic T cells ratio for predicting RE were 1.15, 4.95% and 26.85, respectively. The areas under the ROC curve (AUC) of RE predicted by CD4+/CD8+, B lymphocytes and suppressor/cytotoxic T cells were 0.798 (95%CI: 0.733-0.901), 0.740 (95%CI: 0.634-0.828) and 0.762 (95%CI: 0.658-0.847), respectively. The AUC of combined detection ［0.901（95%CI： 0.795-0.941）］ was significantly higher than those of detection alone, respectively (P<0.05). Conclusion The levels of CD4+/CD8+, B lymphocytes and suppressor/cytotoxic T cells in cervical cancer patients are closely related to the incidence of RE. The lower CD4+/CD8+, the more obvious the decrease of B lymphocytes and the higher the increase of suppressor/cytotoxic T cells, which indicates that the more serious the imbalance of cellular immune function and the higher the probability of RE.
keywords: Cervical cancer Radiation enteritis CD4+/CD8+ B lymphocytes Suppressor T cell Cytotoxic T cell
文章编号： 中图分类号：R737.33 R818.8 文献标志码：A
基金项目:
| Author Name | Affiliation |
| HU Ge, XU Xiu-li, WANG Dan, XIA Fan | The Fourth Department of Comprehensive Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, Anhui 230000, China |
引用文本：
胡格，徐秀理，王丹，夏凡.CD4+/CD8+、B淋巴细胞与抑制/细胞毒性T细胞预测宫颈癌放疗患者放射性肠炎的价值[J].中国临床研究,2022,35(6):779-783.
胡格，徐秀理，王丹，夏凡.CD4+/CD8+、B淋巴细胞与抑制/细胞毒性T细胞预测宫颈癌放疗患者放射性肠炎的价值[J].中国临床研究,2022,35(6):779-783.