鼻颅底肿瘤SALL4,MAGE-A3特异性CTL免疫反应水平及其临床意义  

Specific CTL immune response levels of SALL4 and MAGE-A3 in nasal and skull base tumors and their clinical significance

作　　者：别国梁[1] 黄维平[1] 尹中普[1] 朱萍[1] BIE Guoliang;HUANG Weiping;YIN Zhongpu;ZHU Ping(Department of Otolaryngology,Nanyang Central Hospital(Nanyang Hospital Affiliated to Zhengzhou University),Nanyang Henan 473000,China)

机构地区：[1]南阳市中心医院(郑州大学附属南阳医院)耳鼻喉科一病区

出　　处：《临床与病理杂志》2020年第1期16-22,共7页Journal of Clinical and Pathological Research

摘　　要：目的:探讨鼻颅底肿瘤人类婆罗双树样基因-4(SALL4)和黑色素瘤抗原-A3(MAGE-A3)特异性CTL免疫反应水平及其临床意义。方法:收集2016年5月至2017年12月期间在南阳市中心医院经病理学确诊的鼻颅底肿瘤患者62例作为研究对象。统计所有入选对象血清SALL4,MAGE-A3特异性CTL免疫反应水平数据,分析血清SALL4,MAGE-A3特异性CTL免疫反应频率及强度与患者临床病理参数的关系。以患者4~18个月的随访结果进行分组,将随访期间出现肿瘤复发、转移或死亡等任意一项的患者纳入不良组,其余纳入良好组。绘制ROC曲线分析血清SALL4,MAGE-A3特异性CTL免疫反应水平预测患者预后的效能。结果:鼻颅底肿瘤患者血清中SALL4,MAGE-A3特异性CTL免疫反应频率分别为58.06%(36/62),54.84%(34/62),反应强度分别为4 089.26±263.76 SFC/106 PBMC,2 389.17±167.53 SFC/106 PBMC。血清SALL4,MAGE-A3特异性CTL免疫反应频率及强度在患者的分化程度、肿瘤大小、肿瘤侵袭性之间比较,差异无统计学意义(P>0.05),在TNM分期I^II期与III^IV期的对比,差异有统计学意义(P<0.05)。为期4~18个随访统计,预后不良者30例(48.39%),预后良好者32例(51.61%)。通过ROC曲线分析及最大约登指数计算出血清SALL4,MAGE-A3特异性CTL免疫反应频率及强度的AUC面积为SALL4(0.853),MAGE-A3(0.765)。以最大约登指数计算得出SALL4,MAGE-A3指标的最大AUC面积相应参数截止值,其中SALL4截止值为3 789.178 SFC/10~6 PBMC(灵敏度=81.70%,特异性=92.60%),MAGE-A3截止值为2 342.275 SFC/10~6 PBMC(灵敏度=77.40%,特异性=81.30%)。结论:鼻颅底肿瘤SALL4,MAGE-A3特异性CTL免疫反应频率及强度与患者TNM分期密切相关,在预测患者预后方面具有较强的特异性和灵敏度。鼻颅底肿瘤患者血清SALL4,MAGE-A3免疫反应水平对预后诊断具有指导价值。Objective:To investigate the levels of specific CTL immune response of SALL4 and MAGE-A3 in nasal and skull base tumors and clinical significance.Methods:Sixty-two patients with nasal and skull base tumors confirmed by pathology in our hospital from May 2016 to December 2017 were collected as subjects.Statistical data of serum SALL4 and MAGE-A3 specific CTL immune response levels were collected,and the relationship between serum SALL4 and MAGE-A3 specific CTL immune response frequency and intensity and clinicopathological parameters was analyzed.The patients were followed up for 4 to 18 months,and the prognosis was grouped.The patients who had recurrence,metastasis or death during the follow-up period were included in the poor group and the others in the good group.The ROC curve was drawn to analyze the efficacy of serum SALL4 and MAGE-A3 specific CTL immune response levels in predicting the prognosis of patients.Results:The specific CTL immune response frequencies of SALL4 and MAGE-A3 were 58.06%(36/62) and 54.84%(34/62),respectively.The response intensity of SALL4 and MAGE-A3 were(4 089.26±263.76) SFC/10~6 PBMC and(2 389.17±167.53) SFC/10~6 PBMC,respectively.There was no significant difference in the frequency and intensity of serum SALL4 and MAGE-A3 specific CTL immune response between the degree of differentiation,the size of tumors and the invasiveness of tumors(P>0.05).There was a significant difference between I–II and III–IV stages of TNM(P<0.05).During the follow-up period of 4 to 18 years,there were 30 patients with poor prognosis(poor group),accounting for 48.39%(30/62),32 patients with good prognosis(good group),accounting for 51.61%(32/62).Through ROC curve analysis and maximum Yoden index,the AUC area of serum SALL4 and MAGE-A3 specific CTL immune response frequency and intensity were calculated as SALL4(0.853) and MAGE-A3(0.765).The cut-off values of the maximum AUC area of SALL4 and MAGE-A3 were calculated by the maximum Yoden index.The cut-off values of SALL4 and MAGE-A3 were 3 789.178 SFC/

关 键 词：鼻颅底肿瘤 人类婆罗双树样基因-4 黑色素瘤抗原-A3 酶联免疫斑点法 

分 类 号：R739.4[医药卫生—肿瘤]