乳腺癌患者VEGF-C对血清TNF-α影响术后并发上肢淋巴水肿的中介效应  

Mediating effect of VEGF-C in correlation of serum TNF-αwith postoperative upper extremity lymphedema

作　　者：邱军彦 李文涛 韩智培 QIU Junyan;LI Wentao;HAN Zhipei(Department of Breast Surgery,Henan Provincial People’s Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]河南省人民医院,郑州大学人民医院,河南大学人民医院乳腺外科,450000

出　　处：《淮海医药》2024年第3期245-249,共5页Journal of Huaihai Medicine

摘　　要：目的:分析乳腺癌患者血管内皮生长因子-C(VEGF-C)在血清肿瘤坏死因子-α(TNF-α)与术后并发上肢淋巴水肿的中介效应。方法:选取2018年1月—2022年2月某院接受治疗的乳腺癌术后1年内并发上肢淋巴水肿患者90例为研究组,按照1∶1对照原则,选取该院同期术后1年内未发生上肢淋巴水肿的乳腺癌患者90例为对照组。随访1年,观察患者上肢淋巴水肿变化。比较2组患者及术后2年不同水肿分级的研究组间癌组织VEGF-C表达、血清TNF-α水平。采用Pearson相关系数分析术后1、2年,研究组患者癌组织VEGF-C表达与血清TNF-α、上肢淋巴水肿分级的相关性。构建AMOS 24.0结构方程模型,采用Bootstrap中介效应法评估术后1、2年,癌组织VEGF-C表达对血清TNF-α与术后并发上肢淋巴水肿关联的中介效应。结果:研究组VEGF-C表达阳性率低于对照组,TNF-α水平高于对照组,且不同水肿分级的研究组患者间TNF-α水平呈现:轻度组<中度组<重度组,差异均有统计学意义(P<0.05)。术后2年,研究组中有水肿患者VEGF-C表达阳性率低于无水肿患者,TNF-α水平高于无水肿患者,且不同水肿分级的研究组患者间TNF-α水平呈现:轻度组<中度组<重度组,差异均有统计学意义(P<0.05)。相关分析结果显示,术后1年,血清TNF-α水平与上肢淋巴水肿分级呈正相关(r=0.642,P<0.05);术后2年,癌组织VEGF-C表达与血清TNF-α、上肢淋巴水肿分级呈负相关(r=-0.685、-0.754,P<0.05),血清TNF-α与上肢淋巴水肿分级呈正相关(r=0.669,P<0.05)。中介效应分析显示,术后1年,血清TNF-α水平对术后并发上肢淋巴水肿具有直接预测作用(P<0.05);术后2年,VEGF-C在血清TNF-α影响术后并发上肢淋巴水肿时发挥中介效应。结论:血清TNF-α可通过VEGF-C间接诱导乳腺癌患者术后并发上肢淋巴水肿,尤其在术后2年仍出现水肿时,临床可在乳腺癌术后定期检测患者血清TNF-α,预防上肢淋巴水肿的Objective:To analyze the mediating effect of vascular endothelial growth factor-C(VEGF-C)in the correlation of serum tumor necrosis factor-α(TNF-α)with postoperative upper extremity lymphedema.Methods:90 patients admitted to a hospital from January 2018 to February 2022 were selected as a study group,who developed upper extremity lymphedema one year after the breast cancer surgery.Another 90 patients from the same hospital who did not develop upper extremity lymphedema one year after the operation of breast cancer were chosen as a control group.After one year’s follow-up,the changes of the upper extremity lymphedema were observed.Expression of VEGF-C and serum level of TNF-αbetween the 2 groups and different edema grades 2 years after the operation were compared.Pearson Correlation Coefficient was used to analyze the correlation of VEGF-C expression with serum TNF-αand upper extremity lymphedema grade of the study group patients one or two years after the operation.AMOS 24.0 structural equation modeling was constructed and Bootstrap was used to assess the mediating effect of expression of VEGF-C in the correlation of serum TNF-αwith postoperative upper extremity lymphedema one or two years after the operation.Results:The positive rate of VEGF-C expression in the study group was lower than that of the control group,while TNF-αlevel was higher than that of the control group.TNF-αlevels among patients with different lymphedema grades in the study group demonstrated:mild group<moderate group<severe group,the differences being significant(P<0.05).Two years after the operation,the positive rate of VEGF-C expression of the patients with edema was lower than those without edema in the study group,while TNF-αlevel was higher than that of the patients without edema.TNF-αlevels among patients with different lymphedema grades in the study group demonstrated:mild group<moderate group<severe group,the differences being significant(P<0.05).Correlation analysis showed that one year after the operation,TNF-αlevel was

关 键 词：乳腺肿瘤 血管内皮生长因子-C 肿瘤坏死因子-α 上肢淋巴水肿 中介效应 

分 类 号：R737.9[医药卫生—肿瘤]