PD-L1联合CTLA-4检测在胸腔积液患者胸腔积液及外周血单个核细胞中的表达及意义  

Expression and significance of PD-Li and CTLA-4 in pleural effusion and peripheral blood mononuclear cells in patients with pleural effusion

作　　者：薛珉[1] 颜志军[1] 高习文[1] 庄亚琴[1] 彭清[1] 丁静怡[1] XUE Min YAN Zhijun GAO Xiwen ZHUANG Yaqin PENG Qing DING Jingyi(Department of Respiratory Medicine, Minhang Hospital Affiliated Fudan University, Shanghai 201199, China)

机构地区：[1]上海复旦大学附属闵行医院呼吸内科,201199

出　　处：《疑难病杂志》2017年第2期152-155,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的分析抗程序性死亡配体-1(PD-L1)联合抗细胞毒T淋巴细胞相关抗原-4(CTLA-4)检测在胸腔积液患者胸腔积液及外周血单个核细胞(PBMC)中的表达及其临床意义。方法选择2015年6月—2016年6月上海复旦大学附属闵行医院呼吸内科诊治的胸腔积液患者84例作为研究对象,其中结核性胸腔积液28例,恶性胸腔积液27例,非结核非恶性胸腔积液29例。采用酶联免疫吸附法(ELISA)、聚合酶链反应(PCR)检测患者胸腔积液、PBMC中PD-L1、CTLA-4的表达,并分析二者联合检测对恶性胸腔积液的诊断价值。结果与非结核非恶性胸腔积液比较,恶性胸腔积液患者PBMC中PD-L1、CTLA-4 mRNA,胸腔积液中PD-L1、CTLA-4表达含量显著增高,而结核性胸腔积液患者中上述指标则明显降低(P<0.05);胸腔积液、PBMC中PD-L1与CTLA-4的表达均呈显著正相关(r=0.477,0.418,P<0.05);胸腔积液中PD-L1、CTLA-4联合检测敏感度、特异度分别为92.5%、94.7%,均高于胸腔积液脱落细胞及PD-L1、CTLA-4单独检测,亦高于PBMC的敏感度、特异度。结论胸腔积液患者胸腔积液、PBMC中PDL1、CTLA-4的表达与病因有关,可反映局部微环境下的免疫功能状态,联合检测有助于良恶性胸腔积液的鉴别诊断。Objective To investigate the expression and clinical significance of anti programmed death ligand 1（PDLl） combined with anti cytotoxic T lymphocyte associated antigen（CTLA-4） in pleural effusion and peripheral blood mononuclear cells（PBMC） in patients with pleural effusion.Methods From June 2015 to June 2016 in Shanghai Minhang Hospital Affiliated Fudan University,84 patients who were diagnosed and treated of pleural effusion were enrolled as the research object,including 28 cases of tuberculous pleural effusion and 27 cases of malignant pleural effusion,29 cases of non tuberculous non malignant pleural effusion.Enzyme linked immunosorbent assay（ELISA） and polymerase chain reaction（PCR） were used to detect the expression of PD-Ll,CTLA-4 in PBMC of pleural effusion,and to analyze the diagnostic value of combined detection of two methods for malignant pleural effusion.Results Compared with non tuberculosis non malignant pleural effusion,malignant pleural effusion PBMC＇ s PD-Ll,CTLA-4 mRNA,pleural effusion＇ s PD-1.1 and CTLA-4 expression were significantly increased,while the above indexes in patients with tuberculous pleural effusion was significantly reduced（P〈0.05）;the positive correlation between PD-Ll and CTLA-4 in PBMC and pleural effusion（r =0.477,r =0.418,P〈0.05）;PD-Ll and CTLA-4 in pleural effusion＇s joint detection sensitivity and specificity were respectively 92.5%and94.7%,which were higher than that of pleural effusion exfoliated cells＇ PD-Ll,CTLA-4 separate detection,also its sensitivity and specificity was higher than PBMC.Conclusion The expression of PD-L1.CTLA-4 in pleural effusion,PBMC may he related to the etiology,which can reflect the immune function in the local microenvironment.

关 键 词：抗程序性死亡配体-1 抗细胞毒T淋巴细胞相关抗原-4 胸腔积液 外周血单个核细胞 

分 类 号：R561.3[医药卫生—呼吸系统]