甲状腺乳头状癌患者首次^(131)I治疗前后外周血淋巴细胞亚群的差异分布对^(131)I疗效的预测价值  

Predictive value of the differential distribution of peripheral lymphocyte subsets before and after the first ^(131)I treatment on therapeutic response in patients with papillary thyroid cancer

作　　者：张君宇 樊迪 师志勇 罗天娥[2] 武志芳[1] 王红亮[1] 陆克义[1] 杨素云[1] 吴力翔[1] 胡婷婷[1] 牟媛媛[1] 李思进[1] 刘海燕[1] Zhang Junyu;Fan Di;Shi Zhiyong;Luo Tiane;Wu Zhifang;Wang Hongliang;Lu Keyi;Yang Suyun;Wu Lixiang;Hu Tingting;Mou Yuanyuan;Li Sijin;Liu Haiyan(Department of Nuclear Medicine,First Hospital of Shanxi Medical University、Collaborative Innovation Center for Molecular Imaging of Precision Medicine,Taiyuan 030001,China;Department of Health Statistics,School of Public Health,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院核医学科、分子影像精准诊疗省部共建协同创新中心,太原030001 [2]山西医科大学公共卫生学院卫生统计教研室,太原030001

出　　处：《中华核医学与分子影像杂志》2024年第12期730-735,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(82372009)。

摘　　要：目的探讨首次^(131)I治疗前后外周血淋巴细胞亚群的差异分布对甲状腺乳头状癌(PTC)患者^(131)I治疗效果反应的预测价值。方法回顾性研究2021年1月至2021年8月间山西医科大学第一医院的46例甲状腺全切术后接受^(131)I治疗的PTC患者(男16例、女30例,年龄20~77岁),患者于^(131)I治疗前1~2 d和^(131)I治疗后30 d检测外周血淋巴细胞亚群[T、B、CD4+T、CD8+T、自然杀伤(NK)、辅助性T(Th)1、Th2、Th17和调节性T(Treg)淋巴细胞]的绝对计数。依据血清学和影像学证据,将^(131)I治疗后6~12个月的治疗反应分为疗效满意(ER)和疗效不满意(NER),分析2组间^(131)I治疗前刺激性甲状腺球蛋白(psTg)、临床基线特征差异(两独立样本t检验、配对t检验、Mann-Whitney U检验)和^(131)I治疗前后淋巴细胞亚群对治疗反应的预测价值[logistic回归分析、ROC曲线和决策曲线分析(DCA)]。结果在ER组(33例)和NER组(13例)内,与^(131)I治疗前相比,^(131)I治疗后30 d大部分淋巴细胞亚群有不同程度降低:ER组T、B、CD4+T和Th1淋巴细胞,NER组T、B、CD4+T、Th1、Th2、Th17和Treg淋巴细胞(t值:2.41~9.57,均P<0.05)。^(131)I治疗前NER组psTg水平、Th2、Th17和Treg淋巴细胞数量高于ER组(t值:-3.32~-2.48,U=29.00,均P<0.05),^(131)I治疗后NER组大部分淋巴细胞亚群(T、B、CD4+T、CD8+T、Th1和Treg淋巴细胞)高于ER组但差异均无统计学意义(t值:-1.12~-0.06,均P>0.05)。^(131)I治疗前的Th2淋巴细胞[比值比(OR)=25.00,95%CI:1.36~459.10,P=0.030]是NER的危险因素。ROC曲线分析示,psTg、Th2淋巴细胞预测治疗反应的AUC分别为0.932、0.790,拟合psTg+Th2淋巴细胞亚群的AUC为0.958。DCA示阈值概率为10%~60%时,psTg、Th2淋巴细胞和拟合psTg+Th2淋巴细胞亚群的曲线均高于极端曲线,提示效果较好。结论PTC患者^(131)I治疗后30 d,大部分淋巴细胞亚群呈现不同程度降低,且NER组降低更明显;Th2淋巴细胞可能是^(131)I治疗反应不佳的危�ObjectiveTo investigate the predictive value of differential distribution of peripheral lymphocyte subsets before and after the first ^(131)I treatment on the therapeutic response to ^(131)I treatment in patients with papillary thyroid cancer(PTC).MethodsA retrospective study was conducted on 46 PTC patients(16 males,30 females,age 20-77 years)who underwent total thyroidectomy and received ^(131)I treatment between January 2021 and August 2021 in First Hospital of Shanxi Medical University.Peripheral blood lymphocyte subsets(T,B,CD4+T,CD8+T,natural killer(NK),helper T(Th)1,Th2,Th17,and regulatory T(Treg)cells)were measured 1-2 d before and 30 d after ^(131)I treatment.Based on serological and imaging evidence,therapeutic response at 6-12 months post-^(131)I therapy was categorized as either excellent response(ER)or non-excellent response(NER).Differences of preablative stimulated thyroglobulin(psTg)and clinical baseline characteristics between two groups were assessed by using independent-sample t test,paired t test,or Mann-Whitney U test.Predictive value of lymphocyte subsets before and after ^(131)I treatment for therapeutic response was assessed through logistic regression analysis,ROC curve analysis,and decision curve analysis(DCA).ResultsIn ER group(n=33)and NER group(n=13),most lymphocyte subsets showed different degrees of reduction 30 d after ^(131)I treatment compared to before ^(131)I treatment,such as T,B,CD4+T and Th1 cells in ER group,as well as T,B,CD4+T,Th1,Th2,Th17,and Treg cells in NER group(t values:2.41-9.57,all P<0.05).Before ^(131)I treatment,NER group had significantly higher levels of psTg,Th2,Th17,and Treg cells compared to the ER group(t values:from-3.32 to-2.48,U=29.00,all P<0.05).After ^(131)I treatment,most of lymphocyte subsets in NER group(T,B,CD4+T,CD8+T,Th1 and Treg cells)showed higher trend than those in ER group but without statistical significances(t values:from-1.12 to-0.06,all P>0.05).Th2 cells before ^(131)I treatment(odds ratio(OR)=25.00,95%CI:1.36-459.10,P=0.030)was identif

关 键 词：甲状腺肿瘤 放射疗法 碘放射性同位素 淋巴细胞亚群 治疗结果 预测 

分 类 号：R736.1[医药卫生—肿瘤]