胆道支架联合125I粒子条植入治疗恶性梗阻性黄疸预后因素分析  

Biliary stent placement combined with 125I seed-strip implantation for malignant obstructive jaundice:analysis of prognostic factors

作　　者：郁泽宇 余辉[1] 刁崚峰 尤然 冷斌 徐清宇[1] 尹国文[1] YU Zeyu;YU Hui;DIAO Lingfeng;YOU Ran;LENG Bin;XU Qingyu;YIN Guowen(Department of Interventional Radiology,Jiangsu Provincial Cancer Hospital(Affiliated Cancer Hospital of Nanjing Medical University),Jiangsu Provincial Institute of Cancer Research,Nanjing,Jiangsu Province 223300,China)

机构地区：[1]江苏省肿瘤医院(南京医科大学附属肿瘤医院)介入放射科,江苏省肿瘤研究所,江苏南京210009

出　　处：《介入放射学杂志》2024年第7期758-762,共5页Journal of Interventional Radiology

基　　金：江苏省肿瘤医院自然科学基金(ZJ202215)。

摘　　要：目的 探讨影响恶性梗阻性黄疸(MOJ)患者胆道支架植入联合125I粒子条内放射治疗预后的因素。方法 回顾性分析2019年1月至2023年1月在江苏省肿瘤医院接受胆道支架植入联合125I粒子条内放射治疗的52例MOJ患者临床资料。记录手术前后淋巴免疫细胞数差值(ΔX)。采用X-tile软件计算ΔX最优截断值,并将其分为两组。采用单因素和多因素分析确定影响患者总生存期(OS)的危险因素。结果 52例患者生存时间为(201.0±32.1) d。单因素分析结果显示,术后TACE治疗、术前ALT、术前AST、Δ淋巴细胞、ΔCD3+T细胞、ΔCD8+T细胞、Δ自然杀伤细胞(NK)、Δ调节性T细胞(Treg)与OS显著相关,差异有统计学意义(均P<0.05)。多因素分析结果显示,Δ淋巴细胞(P=0.007)、ΔTreg(P=0.038)是OS独立危险因素。结论 MOJ患者Δ淋巴细胞≥0.237或ΔTreg≥0.21接受胆道支架植入联合125I粒子条内放射治疗,可能获得更长OS。Objective To investigate the factors affecting the prognosis of patients with malignant obstructive jaundice(MOJ)after receiving biliary stent placement combined with intraluminal brachytherapy with 125I seed-strip implantation.Methods The clinical data of 52 patients with MOJ,who received biliary stent placement combined with intraluminal brachytherapy with 125I seed-strip implantation at the Jiangsu Provincial Cancer Hospital of China between January 2019 and January 2023,were retrospectively analyzed.The difference value between preoperative and postoperative number of lymphoid immune cells was recorded asΔX.X-tile software was used to calculate the optimal cut-off value ofΔX,based on which the patients were divided into two groups.Univariate and multivariate analysis were used to determine the risk factors for overall survival(OS).Results The mean survival time of the 52 patients was(201.0±32.1)days.Univariate analysis indicated that postoperative TACE,preoperative ALT,preoperative AST,Δlymphocyte cell,ΔCD3+T cell,ΔCD8+T cell,Δnatural killer cell(NK)andΔregulatory cell(Treg)were significantly associated with OS,the differences were statistically significant(all P<0.05).Multivariate analysis revealed thatΔlymphocyte cell(P=0.007)andΔTreg(P=0.038)were the independent risk factors for OS.Conclusion For MOJ patients whoseΔlymphocyte is≥0.237 orΔTreg is≥0.21,a longer OS can be expected after receiving the treatment of biliary stent placement combined with intraluminal brachytherapy with 125I seed-strip implantation.(J Intervent Radiol,2024,33:758-762)

关 键 词：恶性梗阻性黄疸 胆管癌 胆道支架 125I粒子 预后 

分 类 号：R735.8[医药卫生—肿瘤]