中枢神经系统弥漫大B细胞淋巴瘤脑脊液和血浆细胞因子水平分析  

A Study of Cytokines in Cerebrospinal Fluid and Plasma of Central Nervous System Diffuse Large B Cell Lymphoma

作　　者：邹东梅 刘艳[1] 惠吴函[1] 郭轶先[1] 常晓丽 孙婉玲[1] ZOU Dongmei;LIU Yan;HUI Wuhan;GUO Yixian;CHANG Xiaoli;SUN Wanling(Department of Hematology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血液科,北京100053

出　　处：《标记免疫分析与临床》2023年第3期361-365,393,共6页Labeled Immunoassays and Clinical Medicine

基　　金：北京市自然科学基金(编号:Z200022);首都医科大学宣武医院2021年度国自然青年培育项目(编号:QNPY2021015)。

摘　　要：目的初步探索原发和继发中枢神经系统(CNS)弥漫大B细胞淋巴瘤(DLBCL)患者脑脊液和血浆细胞因子水平特点,及与无CNS累及DLBCL患者的差异。方法回顾性分析首都医科大学宣武医院血液科2019年至2022年收治的初治、检测了脑脊液和血浆细胞因子水平的DLBCL患者83例,根据临床特征分为3组:原发中枢神经系统淋巴瘤(PCNSL)组46例,继发CNSL(SCNSL)组12例,无CNS受累的系统性DLBCL(non-CNSL)组25例。收集患者治疗前血浆及脑脊液12种细胞因子结果,包括IL-1β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12P70、IL-17A、IFN-α、IFN-γ和TNF-α,进行组间比较。结果PCNSL组脑脊液IL-10水平[41.08(6.90,98.73)pg/mL]显著高于SCNSL组[9.13(0.98,26.22)pg/mL]及non-CNSL组[1.58(1.42,1.79)pg/mL],P值分别为<0.0001、0.0185。PCNSL组血浆IL-10[2.20(1.39,2.64)pg/mL]明显低于non-CNSL组[5.49(2.02,21.36)pg/mL]。83例患者中,共有40例患者同时检测了脑脊液和血浆的细胞因子水平,其中PCNSL组23例、SCNSL组10例、non-CNSL组7例。比较脑脊液和血浆的细胞因子水平发现,PCNSL组中69.6%患者(16/23)仅有脑脊液IL-10水平升高、17.4%患者(4/23)脑脊液和血浆IL-10水平同时升高、13.0%患者(3/23)均无升高;SCNSL组患者中10.0%患者(1/10)仅有脑脊液IL-10水平升高、50.0%患者(5/10)脑脊液和血浆IL-10水平同时升高、40.0%患者(4/10)均无升高;non-CNSL组57.1%患者(4/7)仅有血浆IL-10升高、14.3%患者(1/7)脑脊液和血浆IL-10水平同时升高、28.6%患者(2/7)均无升高。脑脊液及血浆IL-10同时升高、且0.2<CSF IL-10/Plasma IL-10<5.0时,对诊断SCNSL的灵敏度为50.0%,特异性为96.4%。结论PCNSL组患者脑脊液IL-10明显高于non-CNSL及SCNSL,血浆IL-10明显低于non-CNSL。当血浆及脑脊液IL-10升高、且脑脊液/血浆IL-10比值为0.2~5.0之间时,其诊断SCNSL具有较高的特异性。Objective To explore levels of cytokines in cerebrospinal fluid(CSF)and plasma of primary and secondary central nervous system(CNS)diffuse large B cell lymphoma(DLBCL),and to compare with those in DLBCL without CNS involvement.Methods 83 DLBCL patients having cytokines measured in CSF and/or plasma before chemotherapy were involved and grouped according clinical features,including 46 patients with primary CNS DLBCL(PCNSL),12 with secondary CNS DLBCL(SCNSL),and 25 DLBCL without CNS involvement(non-CNSL).Data of baseline cytokines,including IL-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12P70,IL-17A,IFN-α,IFN-γand TNF-αwere collected and analyzed.Results CSF IL-10 levels of PCNSL group[41.08(6.90,98.73)pg/mL]were higher than those of SCNSL group[9.13(0.98,26.22)pg/mL;P<0.0001]and non-CNSL group[1.58(1.42,1.79)pg/mL;P=0.0185].Plasma IL-10 levels of PCNSL group[2.20(1.39,2.64)pg/mL]were significantly lower than those of non-CNSL group[5.49(2.02,21.36)pg/mL].40 patients had both CSF and plasma cytokines detected,including 23 patients with PCNSL,10 with SCNSL and 7 with non-CNSL.In PCNSL group,69.6%(16/23)patients had elevated IL-10 levels only in CSF,17.4%(4/23)both in CSF and plasma,and 13.0%(3/23)in neither.In SCNSL group,10.0%(1/10)patient had elevated IL-10 levels only in CSF,50.0%(5/10)both in CSF and plasma,and 40.0%(4/10)in neither.In non-CNSL group,57.1%(4/7)patients had elevated IL-10 levels only in plasma,14.3%(1/7)both in CSF and plasma,and 28.6%(2/7)in neither.Using both elevated CSF and plasma IL-10 levels,and 0.2<CSF IL-10/plasma IL-10<5.0,the diagnostic sensitivity and specificity of SCNSL were 50.0%and 96.4%,respectively.Conclusion CSF IL-10 levels of PCNSL group are significantly higher than those of SCNSL and non-CNSL group,while plasma IL-10 levels of PCNSL group are lower than those of non-CNSL group.CSF and plasma IL-10 are reliable biomarkers to differentiate SCNSL from PCNSL and non-CNSL.

关 键 词：弥漫大B细胞淋巴瘤 中枢神经系统 脑脊液 血浆 细胞因子 

分 类 号：Q733.4[生物学—分子生物学]