气管支气管恶性病变狭窄患者肺泡灌洗液中TNF-α和Th1/Th2对再狭窄的预测价值

Predictive value of TNF-αand Th1/Th2 levels in alveolar lavage fluid for the restenosis in patients with malignant stenosis of trachea and bronchus

目的探讨气管支气管恶性病变狭窄患者肺泡灌洗液中肿瘤坏死因子-α(TNF-α)和辅助性T细胞(Th)1/Th2对再狭窄的预测价值。方法选取我院2019年2月至2021年8月收治的140例气管支气管恶性病变狭窄患者作为研究对象。全部患者均接受气管镜下介入手术治疗,并于术后随访3个月,观察记录患者术后再狭窄情况;调查患者基线资料,并收集肺泡灌洗液,检测肺泡灌洗液中TNF-α、癌胚抗原(CEA)和Th1/Th2比值和其他相关血清学指标,比较患者基线资料、实验室指标;分析肺泡灌洗液中TNF-α、CEA和Th1/Th2比值预测气管支气管恶性病变狭窄患者再狭窄的价值。结果140例气管支气管恶性病变患者中,有26例术后发生再狭窄,发生率为18.57%。再狭窄组肺泡灌洗液中TNF-α和CEA水平均高于非再狭窄组,Th1/Th2比值低于非再狭窄组(均P<0.05);组间其他基线资料和实验室指标比较差异无统计学意义(P>0.05);经点二列相关性检验分析结果显示,TNF-α、Th1细胞水平和Th1/Th2比值与气管支气管恶性病变狭窄患者术后再狭窄呈正相关性(r=0.317、0.337、0.211、0.517,P<0.05),Th2细胞水平与气管支气管恶性病变狭窄患者术后再狭窄呈负相关性(r=-0.449,P<0.05);绘制受试者工作特征(ROC)曲线图,肺泡灌洗液中TNF-α和Th1/Th2比值单独及联合预测对患者术后再狭窄均有一定预测价值,且以联合预测的价值最好;绘制决策曲线显示,在阈0.10~0.18、0.20~0.24、0.41~0.51、0.82~0.89、0.90~0.94范围内,联合肺泡灌洗液中TNF-α和Th1/Th2比值的预测模型预测气管支气管恶性病变狭窄患者术后再狭窄净收益率优于单独TNF-α或Th1/Th2比值。结论气管支气管恶性病变狭窄患者肺泡灌洗液中TNF-α和Th1/Th2比值可用于预测再狭窄,预测价值较好。

Objective To investigate the predictive value of tumor necrosis factor-α(TNF-α)and helper T cell(Th)1/Th2 levels in alveolar lavage fluid for the restenosis in patients with malignant stenosis of trachea and bronchus.Methods 140 patients with malignant stenosis of trachea and bronchus treated in our hospital from February 2019 to August 2021 were selected as the research subjects.All the patients received surgical treatment and were followed up for 3 months;the baseline data of patients were investigated,alveolar lavage fluid was collected,TNF-α,carcinoembryonic antigen(CEA),Th1/Th2 ratio and other relevant serological indicators in alveolar lavage fluid were detected,and the baseline data and laboratory indicators of patients were compared;the value of TNF-α,CEA and Th1/Th2 ratio in alveolar lavage fluid in predicting the restenosis in patients with malignant stenosis of trachea and bronchus was mainly analyzed.Results Among 140 patients with malignant stenosis of trachea and bronchus,26 cases developed the restenosis with an incidence of 18.57%;the levels of TNF-αand CEA in alveolar lavage fluid in the restenosis group were higher than those in the non-restenosis group,and the ratio of Th1/Th2 was lower than that in the non-restenosis group(P<0.05);there were no statistically significant differences in other baseline data and laboratory indexes between two groups(P>0.05);According to the point two column correlation test and analysis,the results showed that the levels of TNF-α,Th1 cells and Th1/Th2 ratio were positively correlated with postoperative restenosis in the patients with malignant tracheal and bronchial stenosis(r=0.317,0.337,0.211,0.517,P<0.05),the level of Th2 cells was negatively correlated with postoperative restenosis in the patients with malignant stenosis of trachea and bronchus(r=-0.449,P<0.05);the receiver operating characteristic(ROC)curve showed TNF-αand Th1/Th2 ratio in alveolar lavage fluid alone and in combination for predicting postoperative restenosis all had a certain predictive value,and the combined prediction was the best;the decision curve showed that the net benefit of the combined prediction model of TNF-αand Th1/Th2 ratio in alveolar lavage fluid was better than TNF-αor Th1/Th2 ratio alone in predicting postoperative restenosis in the patients with malignant stenosis of trachea and bronchus in the range of threshold 0.10-0.18,0.20-0.24,0.41-0.51,0.82-0.89 and 0.90-0.94.Conclusions TNF-αand Th1/Th2 ratio in alveolar lavage fluid of the patients with malignant stenosis of trachea and bronchus can be used to predict restenosis,and the predictive value is good.