Th1/Th2细胞因子在急性髓系白血病预后分层中的意义  

Significance of Th1/Th2 cytokines in prognostic stratification of acute myeloid leukemia

作　　者：李增政 宫跃敏 王娅婕 胡芃[1] 高丽丽 杨同华[1] 赵仁彬[1] Li Zengzheng;Gong Yuemin;Wang Yajie;Hu Peng;Gao Lili;Yang Tonghua;Zhao Renbin(Department of Hematology,the First People's Hospital of Yunnan Province,Kunming 650032,China;Department of Hematology,Jiangsu Provincial People's Hospital,Nanjing 210029,China)

机构地区：[1]云南省第一人民医院血液内科,昆明650032 [2]江苏省人民医院血液内科,南京210029

出　　处：《白血病．淋巴瘤》2021年第8期461-465,共5页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金青年基金(81700164);云南省科技厅-昆明医科大学应用基础研究联合专项资金(2018FE001(-156));云南省应用基础研究计划面上项目(2018FB112);云南省卫生和计划生育委员会医学后备人才培养计划(H2017012);云南省血液疾病临床医学中心开放课题(2019LCZXKF-XY02、2019LLZXKF-XY11、2020LCZXKF-XY07、2020LCZXKF-XY14);云南省第一人民医院博士科研基金(KHBS-2020-007)。

摘　　要：目的探讨Th1/Th2细胞因子在急性髓系白血病(AML)预后分层中的意义。方法收集2017年6月至2019年4月于云南省第一人民医院初诊AML患者83例,根据成年人急性髓系白血病(非急性早幼粒细胞白血病)中国诊疗指南(2017年版)将AML患者分为预后不良组(45例)、预后中等组(19例)、预后良好组(19例),其中预后中等+预后不良为预后非良好。利用Mann-Whitney U检验和Kruskal-Wallis H检验比较不同预后组外周血Th1/Th2细胞因子表达的差异;选取不同预后组间差异有统计学意义的细胞因子,利用受试者工作特征(ROC)曲线确定细胞因子预测不同预后分层AML患者的cut-off值;以cut-off值为界,将所有患者分为≥cut-off值组和<cut-off值组,分析两组与指南预后分层间的关系。结果预后中等组患者肿瘤坏死因子(TNF)-β的中位表达量[3.80 pg/ml(2.75 pg/ml,15.32 pg/ml)]高于预后不良组患者[2.78 pg/ml(1.28 pg/ml,3.36 pg/ml)]和预后良好组患者[1.61 pg/ml(0.83 pg/ml,3.04 pg/ml)](U=216,P=0.02;U=312,P<0.05);预后良好组患者低于预后不良组(U=562,P=0.048)。其他Th1/Th2细胞因子表达水平在不同预后分层的AML患者中差异均无统计学意义(均P>0.05)。预测预后良好组和预后中等组的TNF-βcut-off值为3.23 pg/ml,ROC曲线下面积为0.866(95%CI 0.753~0.978,P<0.05);TNF-β≥3.23 pg/ml的26例患者中,25例(96.2%)为预后非良好。预测预后中等组和预后不良组的TNF-βcut-off值为3.62 pg/ml,ROC曲线下面积为0.747(95%CI 0.610~0.884,P=0.02);TNF-β≥3.62 pg/ml的18例(100%)患者均为预后非良好。预测预后良好组和预后非良好组的TNF-βcut-off值为2.19 pg/ml,ROC曲线下面积为0.719(95%CI 0.595~0.842,P=0.04);TNF-β≥2.19 pg/ml的53例患者中,46例(86.8%)为预后非良好。结论TNF-β的高表达可能提示AML患者预后非良好,当TNF-β≥3.62 pg/ml时可能有助于对AML患者预后分层。Objective To investigate the significance of Th1/Th2 cytokines in prognostic stratification of acute myeloid leukemia(AML).Methods A total of 83 patients with newly diagnosed AML from June 2017 to April 2019 in the First People's Hospital of Yunnan Province were collected.According to the Chinese guidelines for diagnosis and treatment of adult acute myeloid leukemia(non-acute promyelocytic leukemia)(2017 edition),AML patients were divided into poor prognosis group(45 cases),moderate prognosis group(19 cases),and good prognosis group(19 cases);moderate prognosis plus poor prognosis was treated as the not good prognosis.Mann-Whitney U test and Kruskal-Wallis H test were used to compare the expression differences of Th1/Th2 cytokines in peripheral blood of different prognosis groups;cytokines with statistical differences among different prognosis groups were selected,and the cut-off value of AML patients with different prognostic stratification distinguished by cytokines was determined by using receiver operating characteristic(ROC)curve.Finally,patients were divided into≥cut-off value group and<cut-off value group according to the cut-off value,and then the association of both groups with the prognostic stratification in guideline was also analyzed.Results The median expression level of tumor necrosis factor(TNF)-βof patients in moderate prognosis group[3.80 pg/ml(2.75 pg/ml,15.32 pg/ml)]was higher than that of patients in poor prognosis group[2.78 pg/ml(1.28 pg/ml,3.36 pg/ml)]and good prognosis group[1.61 pg/ml(0.83 pg/ml,3.04 pg/ml)](U=216,P=0.02;U=312,P<0.05);the median expression level of TNF-βin good prognosis group was lower than that in poor prognosis group(U=562,P=0.048).There were no statistically significant differences in the expression levels of Th1/Th2 cytokines of AML patients with different prognostic stratification(all P>0.05).The cut-off value of TNF-βwas 3.23 pg/ml in good prognosis group and moderate prognosis group,the area under the ROC curve was 0.866(95%CI 0.753-0.978,P<0.05);among 26 pa

关 键 词：白血病 髓样 急性 TH1细胞 TH2细胞 细胞因子类 肿瘤坏死因子类 白细胞介素类 预后 

分 类 号：R733.71[医药卫生—肿瘤]