血液中TGF-β、IL-6及ACE含量在预测放射性肺炎中的价值

Predictive effect of plasma TGF-beta, IL-6, and ACE level for radiation pneumonitis

目的评价放疗前血液中TGFβ、IL6及ACE含量及照射40～50Gy含量变化与放射性肺炎关系。方法42例入选患者按治疗常规给予放疗或(和)化疗;男38例,女4例,中位年龄57岁(40～81岁);肺癌39例,食管癌2例,胸腺瘤1例。放疗前、照射40～50Gy时采血冻存,采用酶联免疫吸附法统一检测血液中TGFβ、IL6及ACE含量。放射性肺炎按RTOG急性放射性肺炎标准评价,评价终点为≥2级放射性肺炎。统计方法采用SPSS10.0软件。结果13例发生了放射性肺炎,与未发生放射性肺炎的TGFβ疗前含量分别为7.73、7.48ng/ml(P=0.920),照射40～50Gy时分别为4.91、3.88ng/ml(P=0.250);IL6疗前含量分别为5.08、7.06pg/ml(P=0.740),照射40～50Gy时分别为21.75、6.78pg/ml(P=0.190);ACE含量疗前分别为394.17、518.22ng/ml(P=0.020),照射40～50Gy时分别为375.52、497.32ng/ml(P=0.050)。疗前ACE<365ng/ml者6/10发生了放射性肺炎,ACE>365ng/ml者6/30发生放射性肺炎(P=0.040)(2例未测)。照射40～50Gy时,TGFβ及IL6升高者放射性肺炎的发生有所增加,但差异无统计学意义。结论ACE含量有望作为检测放射性肺炎易感性的指标。

Objective To study the relationship between level of plasma transform growth factor-beta （TGF-beta）, interleukin-6 （IL-6）, angiotensin-converting enzyme （ACE） and radiation pneumonitis （RP） in patients receiving thoracic irradiation. Methods From February 2004 to December 2004, 42 patients were allotted into this study. Thirty-eight patients were male and 4 female, with a median age of 57 years （40-81 years）. Thirty-nine patients had lung cancer, two esophageal carcinoma, and one thymoma. Radiation doses ranged from 46 Gy to 70 Gy, with a median of 60 Gy. V20 ranged from 10% to 31%, with a median of 23.5%. Blood samples were collected and frozen before radiotherapy （Pre-RT） and at 40-50 Gy（Pust-RT）. TGF-beta, IL-6, and ACE levels were measured with enzyme-linked immunosorbent assay （ELISA）. Radiation pneumonitis was graded according to RTOG/EORTC acute radiation pneumonitis criteria. Grade 2 or more RP was taken as the main end point. Results Thirteen patients out of 42 developed RP. Between the RP and non-RP group, there was no difference in pre- or post-RT level of TGF-beta. In addition, the difference in pre-RT level of IL-6 between the two groups was also statistically insignificant. However, we observed a trend towards a higher post-RT IL-6 level in the RP group compared to the non-RP group. ACE level was lower in RP group than in the non-RP group, both prior to RT and at a dose when 40-50 Gy was reached （ P = 0.020 and 0.050）. The incidence of RP was slightly higher in patients who had increased post-RT TGF-beta or IL-6 level. Six out of ten patients （60%） whose pre-RT ACE value was less than 365 ng/ml experienced RP, versus only 6 out of 30 whose ACE value was higher than 365 ng/ml. Conclusion This study suggests that ACE level before or during thoracic irradiation has a predictive value risking for radiation pneumonitis.