诱导痰及血清TGF-β1水平对非小细胞肺癌急性放射性肺炎的预测价值  

TGF-β1 in serum and induced sputum for predicting radiation pneumonitis in patients with non-small cell lung cancer after radiotherapy

作　　者：王静[1,2] 乔学英[1] 卢付河[1] 周志国[1] 宋玉芝[1] 霍俊杰[1,3] 刘欣[1] 

机构地区：[1]河北医科大学第四医院放疗一科,河北石家庄050011 [2]唐山开滦医院肿瘤科,河北唐山064200 [3]邢台医学高等专科学校基础部,河北邢台054300

出　　处：《癌症》2010年第3期353-358,共6页Chinese Journal of Cancer

基　　金：河北省科技厅支持项目(012761224)~~

摘　　要：背景与目的:较多研究证实TGF-β1是放射性肺炎(radiation pneum onitis,RP)发生相关的细胞因子之一,然而应用血清TGF-β1水平预测RP的临床价值仍有争议。本研究旨在探讨诱导痰及血清TGF-β1预测急性放射性肺损伤发生的价值,为非小细胞肺癌(non-small cell lung cancer,NSCLC)的放疗提供参考。方法:收集2007年11月至2009年1月经病理学证实为NSCLC并在河北医科大学第四医院放疗科接受3D-CRT的23例患者的临床资料。放疗前及放疗近结束时空腹采肘静脉血并做雾化诱导痰,用酶联免疫吸附法检测血清TGF-β1水平,用免疫细胞化学染色方法检测诱导痰沉渣涂片中TGF-β1表达情况。放疗开始至结束后3个月内每周按RTOG急性放射损伤分级标准评价急性放射性肺炎。结果:全组患者随访期间发生急性RP9例,总发生率为39.1%(9/23),2级及以上急性RP发生率为30.4%(7/23)。放疗后血清TGF-β1水平升高的患者RP发生率较下降者高,分别为45.5%和40.0%,但差异无统计学意义(P=1.000)。治疗有效且血清TGF-β1水平升高的患者RP发生率为50.0%,治疗无效且血清TGF-β1水平升高者RP发生率为33.3%,两者差异无统计学意义(P=0.792)。免疫细胞化学染色显示诱导痰中可见TGF-β1表达,定位于巨噬细胞及上皮细胞胞浆,呈棕黄色,并以巨噬细胞表达为主。放疗后较放疗前诱导痰中TGF-β1表达有升高趋势(分别为71.4%和28.6%,P=0.015)。放疗后诱导痰中TGF-β1阳性的患者RP发生率较阴性者高(分别为46.7%和14.3%),但差异无统计学意义(P=0.193)。结论:放疗后诱导痰中TGF-β1阳性者RP发生率有升高趋势,有可能成为RP的预测因子。Background and Objective：Research has confirmed that transforming growth factor-β1 （TGF-β1） is one of the cytokines related to radiation pneumonitis. But the level of TGF-β1 in serum needed to predict radiation pneumonitis is still not clear. This study assessed the value of TGF-β1 in both serum and induced sputum in predicting radiation pneumonitis,providing a reference for the radiotherapy of patients with non-small cell lung cancer （NSCLC）. Methods： A total of 23 patients with NSCLC treated with three-dimensional conformal radiotherapy （3D-CRT） or intensity-modulated radiation therapy （IMRT） in our department between November 2007 and January 2009 were analyzed and evaluated. TGF-β1 levels in both serum and sputum were detected before and near the end of radiotherapy for all the patients. The TGF-β1 level in serum was measured with enzyme-linked immunosorbent assay （ELISA）. Immunocytochemistry assays were used to detect TGF-β1 expression in sputum sediment. Radiation pneumonitis was graded according to Radiation Therapy Oncology Group （RTOG） radiation scoring criteria every 3 weeks from the start to 3 months after the end of treatment. Results： Radiation pneumonitis was noted in 9 patients in this cohort. The total incidence of radiation pneumonitis was 39.1% （9/23） and those with Grade II or worse was 30.4% （7/23）. The absolute TGF-β1 level in serum after radiotherapy was higher than before radiotherapy,but there was no statistical difference （ P=0.139）. Patients with increased levels of TGF-β1 had a higher incidence of radiation pneumonitis （45.5%） than those with decreased TGF-β1 levels post-radiotherapy （40.0%）. Though there was a tendency of higher incidence of radiation pneumonitis with increases in TGF-β1 level,no statistical difference was found （ P=1.000）. Patients with tumor response had higher incidence of radiation pneumonitis （50.0%） than patients without when TGF-β1 levels in serum increased,but there was no statistical differe

关 键 词：肺肿瘤 非小细胞肺癌 三维适形放疗 急性放射性肺炎 转化生长因子-Β1 诱导痰 

分 类 号：R734.2[医药卫生—肿瘤]