血清ctDNA及miR-21、IL-17、vWF与弥漫大B细胞淋巴瘤患者R-CHOP疗效的关系研究  

Correlation of serum ctDNA,miR-21,IL-17 and vWF with the efficacy of R-CHOP in patients with diffuse large B-cell lymphoma

作　　者：张朦 许晶 丁曼华 徐海亭[1] 张涛[1] ZHANG Meng;XU Jing;DING Manhua;XU Haiting;ZHANG Tao(Department of Cancer Radiotherapy,Xuzhou Cancer Hospital,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州市肿瘤医院肿瘤放疗科,江苏徐州221000

出　　处：《国际检验医学杂志》2023年第16期1988-1992,1999,共6页International Journal of Laboratory Medicine

摘　　要：目的探讨血清循环肿瘤DNA(ctDNA)及微小核糖核酸-21(miR-21)、白细胞介素-17(IL-17)、血管性血友病因子(vWF)与弥漫大B细胞淋巴瘤(DLBCL)患者R-CHOP疗效的关系。方法选取2016年4月至2022年4月在该院确诊并收治的109例DLBCL患者为研究对象,分析其治疗前后的血清ctDNA、miR-21、IL-17、vWF水平,比较DLBCL患者R-CHOP疗效无效和有效组的资料情况及血清ctDNA、miR-21、IL-17、vWF水平,多因素Logistic回归模型研究DLBCL患者R-CHOP疗效的影响因素,受试者工作特征(ROC)曲线评估上述4个指标预测DLBCL患者R-CHOP疗效的效能。结果与治疗前比较,DLBCL患者治疗后血清ctDNA、miR-21、vWF水平明显降低,IL-17水平明显增高,差异有统计学意义(P<0.05)。与有效组比较,无效组Ann Arbor分期(Ⅰ~Ⅱ期/Ⅲ~Ⅳ期)、国际预后指数(IPI)评分(0~2分/3~5分)、脾大(否/是)、贫血(否/是)、乳酸脱氢酶≥220 IU/L(否/是)、球蛋白>34 g/L(否/是)、化疗期间感染(否/是)比例及血清ctDNA、miR-21、vWF水平明显增高,IL-17水平明显降低,差异有统计学意义(P<0.05)。IPI评分3~5分及血清ctDNA、miR-21、IL-17、vWF水平为DLBCL患者R-CHOP疗效的影响因素(P<0.05)。绘制ROC曲线发现,血清ctDNA、miR-21、IL-17、vWF联合预测DLBCL患者R-CHOP疗效的效能[曲线下面积(AUC)=0.821]要高于各指标单独应用(AUC=0.706、0.652、0.638、0.677),其预测灵敏度与特异度依次为66.72%、92.32%,截断值依次为102.9 ng/mL、1.59、8.51 pg/mL、9.61μg/mL。结论血清ctDNA、miR-21、vWF增高及IL-17降低的DLBCL患者其R-CHOP疗效较差,4个指标对DLBCL患者R-CHOP疗效有一定预测价值,有望成为DLBCL疗效评估的潜在标志物。Objective To explore the correlation of serum circulating tumor DNA(ctDNA),microRNA-21(miR-21),interleukin-17(IL-17),and von Willebrand factor(vWF) with the efficacy of rituximab plus cyclophosphamide,doxorubicin,vincristine,and prednisone regimen(R-CHOP) in patients with diffuse large B-cell lymphoma(DLBCL).Methods One hundred and nine patients with DLBCL diagnosed and treated in a hospital from April 2016 to April 2022 were enrolled.The pre-and post-treatment levels of ctDNA,miR-21,IL-17,vWF in serum were detected.The clinical data,serum levels of ctDNA,miR-21,IL-17 and vWF were compared between R-CHOP ineffective and effective groups.Multivariate Logistic regression model was used to study the influencing factors affecting the R-CHOP efficacy in DLBCL patients,and the receiver operating characteristic(ROC) curve was used to evaluate the efficacy of the above four indicators in predicting the efficacy of R-CHOP in DLBCL patients.Results Compared with before treatment,the levels of serum ctDNA,miR-21 and vWF in DLBCL patients after treatment were significantly decreased,and the level of IL-17 was significantly increased,with statistical significance(P<0.05).Compared with the effective group,in the ineffective group,the proportion of Ann Arbor stage(stage Ⅰ to Ⅱ/stage Ⅲ to Ⅳ),international prognostic index(IPI) score(0 to 2 points/3 to 5 points),spleen enlargement(no/yes),anemia(no/yes),lactic dehydrogenase ≥220 IU/L(no/yes),globulin 34 g/L(no/yes) and infection during chemotherapy(no/yes) and the levels of serum ctDNA,miR-21 and vWF were significantly increased,while the level of IL-17 was significantly decreased,with statistical significance(P<0.05).IPI score 3-5 points and serum ctDNA,miR-21,IL-17 and vWF levels were the influencing factors of R-CHOP efficacy in DLBCL patients(P<0.05).The ROC curve showed that the combined prediction efficacy of serum ctDNA,miR-21,IL-17 and vWF for R-CHOP in DLBCL patients [area under the curve(AUC) =0.821]was higher than that of each index applied alone(AUC=0.706,0.

关 键 词：循环肿瘤DNA 微小核糖核酸-21 白细胞介素-17 血管性血友病因子 弥漫大B细胞淋巴瘤 

分 类 号：R733.1[医药卫生—肿瘤]