摘要
目的探讨血清炎症因子水平与分化型甲状腺癌(DTC)^(131)I治疗疗效之间的关系及^(131)I治疗对炎症因子水平的影响。方法收集2020-07-01-2020-09-30于重庆医科大学附属第一医院行首次^(131)I治疗的126例DTC患者,根据治疗反应分为反应良好(ER,65例)和反应欠佳(NER,61例)组。根据不同炎症因子水平的临床测值参考范围分别将其分为阳性组[白介素-6(IL-6)≥2.0 ng/L:15例;白介素-10(IL-10)≥5.0 ng/L:7例;肿瘤坏死因子-α(TNF-α)≥4.0 ng/L:117例]和阴性组(IL-6:111例;IL-10:119例;TNF-α:9例)。分析指标采用分类数据描述,组间差异采用χ~2检验、非参数秩和检验。对可能影响NER的因素纳入二分类logistic回归分析。结果ER与NER组间治疗前血清IL-6、IL-10、TNF-α水平差异无统计学意义,P>0.05。单因素分析显示肿瘤直径>2.0 cm(OR=2.500,95%CI:0.236~26.480,P=0.045)、淋巴结转移数目≥5个(OR=4.316,95%CI:2.011~9.262,P<0.001)、中高危(OR=22.667,95%CI:2.561~200.624,P=0.048)、淋巴结阳性比≥0.4(OR=2.127,95%CI:0.994~4.551,P=0.047)和^(131)I治疗前刺激性血清甲状腺球蛋白(ps-Tg)≥2.3 ug/L(OR=2.054,95%CI:0.986~4.281,P=0.046)可能是NER的危险因素。进一步多因素分析结果显示,淋巴结转移数目≥5个是NER的独立危险因素(OR=3.684,95%CI:1.600~8.481,P=0.002)。IL-6、IL-10、TNF-α阳性组与阴性组组间临床特征差异无统计学意义,P>0.05;^(131)I治疗可能改变血清甲状腺球蛋白(Tg)、促甲状腺激素(TSH)、抗甲状腺球蛋白抗体(TgAB)、甲状腺微粒体抗体(TMAB)和IL-6水平,t值分别为-7.577、-9.742、-4.698、-1.353和-2.459,P值分别为<0.001、<0.001、<0.001、<0.001和0.010。结论炎症因子水平与NER无明显关联;^(131)I治疗可能改变DTC炎症微环境。
Objective To explore the relationship between the level of serum inflammatory factors and the efficacy of ^(131)I treatment for differentiated thyroid(DTC)carcinoma.Methods Totally,126 patients with DTC who were treated with ^(131)I for the first time in First Affiliated Hospital of Chongqing Medical University were divided into excellent response(ER)and non-excellent response(NER)according to treatment response(65 patients in ER group,61 patients in NER group).According to the clinical reference range of different levels of IL-6,IL-10,TNF-α,they were divided into positive group(IL-6≥2.0 ng/L:15 patients;IL-10≥5.0 ng/L:7 patients;TNF-α≥4.0 ng/L:117 patients,separately)and negative group(111,119,9 cases,separately).Two test and non-parametric statistical test were used for between-group comparison.The logistic regression analysis was used to analyze the related factors of NER.Results There was no significant difference in IL-6,IL-10 and TNF-αbetween ER and NER groups before treatment.Univariate analysis showed tumor diameter>2.0cm(OR=2.500,95%CI:0.236-26.480,P=0.045),number of lymph node metastasis≥5(OR=4.316,95%CI:2.011-9.262,P<0.001),medium and high risk(OR=22.667,95%CI:2.561-200.624,P=0.048),lymph node ratio≥0.4(OR=2.127,95%CI:0.994-4.551,P=0.047)and Pre-ablation stimulated thyroglobulin(ps-Tg)≥2.3μg/L may be risk factors for NER(OR=2.054,95%CI:0.986-4.281,P=0.046).Further multivariate analysis showed that only number of lymph node metastasis≥5 was an independent risk factor for NER(OR=3.684,95%CI:1.600-8.481,P=0.002).There was no significant difference in clinical characteristics between the positive IL-6,IL-10,TNF-αgroup and the negative group.^(131)I treatment may change the levels of thyroglobulin(Tg),thyroid stimulating hormone(TSH),anti-thyroglobulin antibodies(TgAB),Thyroid Microsomal Antibody(TMAB)and IL-6(t values were-7.577,-9.742,-4.698,-1.353,-2.459,Pvalues were<0.001,<0.001,<0.001,<0.001,0.010,respectively).Conclusions There was no significant correlation between the level of inflammatory factors and NER.^(131)I treatment may change the inflammatory microenvironment of DTC.
作者
刘双
周春燕
左睿
陈淼
何佳航
段东
LIU Shuang;ZHOU Chun-yan;ZUO Rui;CHEN Miao;HE Jia-hang;DUAN Dong(Department of Nuclear Medicine,First Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Nuclear Medicine,Chongqing People's Hospital,Chongqing 401120,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2022年第12期921-928,共8页
Chinese Journal of Cancer Prevention and Treatment
基金
重庆市自然科学基金(面上项目)(cstc2019jcyj-msxmX0327)。
