宫颈癌放疗患者临床特征、DVH参数及血清细胞因子预测急性放射性肠炎发病的前瞻性队列研究  

Prospective cohortstudy of clinical characteristics,DVH parameters and serum cytokines predicting onset ofacute radiation enteritis in patients with cervical cancertreated with radiotherapy

作　　者：戴颖 臧春宝[1] 张余飞 柯学[1] 刘云琴[1] DAI Ying;ZANG Chunbao;ZHANG Yufei;KE xue;LIU Yunqin(Department of Radiation Oncology,Anhui Provincial Cancer Hospital,Hefei 230000,China)

机构地区：[1]安徽省肿瘤医院放疗科,合肥230000

出　　处：《新疆医科大学学报》2024年第1期86-91,97,共7页Journal of Xinjiang Medical University

基　　金：安徽省自然科学基金项目(2108085B69)。

摘　　要：目的探讨宫颈癌放疗患者临床特征、放疗剂量体积直方图(Dose volume histogram,DVH)参数及放疗前血清细胞因子水平等指标对急性放射性肠炎(Acute radiation enteritis,ARE)的预测作用。方法以2022年3月-2022年12月在安徽省肿瘤医院放疗科接受放射治疗的48例宫颈癌患者为研究对象,记录患者的DVH参数、临床特征(年龄、BMI、疾病分期、病理类型等),收集患者放疗前后的静脉血样本,采用多重微球流式荧光法测定血浆中细胞因子(IL-4、IL-6、IL-10、IL-12p70、IL-17、IFN-γ、TNF-α)的水平。比较以各因素分组ARE的发生率,比较ARE组与非ARE组DVH参数与细胞因子水平。采用Logistic回归分析筛选与ARE发生的相关因素,并采用受试者工作特征Receiver operating characteristic,ROC)曲线分析单因素及多因素模型预测ARE的价值。结果临床特征、DVH参数及细胞因子水平在ARE组及非ARE组间无差异;以放疗前IL-12p70中位数分组,IL-12p70高水平组ARE发生率较低(P<0.05),以其余细胞因子、DVH参数分组、组间ARE发生率、组间细胞因子水平、DVH参数,ARE发生率差异无统计学意义(P>0.05);Logistic回归分析结果显示临床分期、放疗前血清IL-12p70、IL-17水平与ARE发生相关(P<0.05)。ROC曲线分析结果显示含分期、IL-12p70大于中位数、IL-17大于中位数三因素的联合模型具有较高的预测ARE发生的效能(AUC=0.838,P<0.0001)。结论分期、IL-12p70大于中位数、IL-17大于中位数三因素的联合模型对ARE的发生具有预测价值。Objective To investigate the predictive effects of clinical characteristics,dose volume histogram(DVH)parameters and pre-radiotherapy serum cytokine levels on acute radiation enteritis(ARE)in patients with cervical cancer treated with radiotherapy.Methods 48 patients with cervical cancer who underwent radiotherapy from March 2022 to December 2022 in the hospital were enrolled.The DVH parameters,clinical characteristics(age,BMI,disease stage,pathological type,etc.)of the patients were recorded,and venous blood samples before and after the radiotherapy were collected to examine the plasma cytokines level(IL-4,IL-6,IL-10,IL-12p70,IL-12p70 and IL-12p70)using multi-beads flow fluorescence technology.The incidence of ARE among the groups was compared.The DVH parameters and cytokine levels were compared between the ARE group and the non-ARE group.Logistic regression was used to screen the factors that related to the occurrence of ARE.Receiver operating characteristic(ROC)curves were used to evaluate the value of single factors and the multi-factor-model in predicting ARE.Results Clinical characteristics,DVH parameters and cytokine levels did not differ between the ARE and non-ARE groups.Grouped by the median of IL-12p70 before the radiotherapy,the incidence of ARE was lower in IL-12p70 high level group(P<0.05),and there was no statistically significant difference in cytokine levels,DVH parametersand ARE incidence between the groups(P>0.05).The results of Logistic regression analysis showed that clinical staging,serum IL-12p70 and IL-17 levels before theradiotherapy were correlated with the occurrence of ARE(P<0.05).The ROC curve analysis results showed that the joint model with stage,IL-12p70 was greater than median,and IL-17 greater than median had high predictive power for ARE occurrence(AUC=0.838,P<0.0001).Conclusion The combined model containing the 3 factors of staging,IL-12p70 and IL-17 had predictive value for the occurrence of ARE.

关 键 词：宫颈癌 放疗 急性放射性肠炎 细胞因子 预测 

分 类 号：R737.3[医药卫生—肿瘤]