肿瘤坏死因子α在不同类型淋巴瘤患者中的表达及其临床预后意义

Clinical implications of tumor necrosis factor-α in lymphomas

目的 探讨肿瘤坏死因子α（TNF-α）在不同类型淋巴瘤患者中的表达及其临床预后意义.方法 以88例不同类型淋巴瘤患者和88名健康志愿者为研究对象,采用免疫组化和双抗体夹心酶联免疫吸附（ELISA）法测定其石蜡组织和血浆标本中TNF-α的表达水平,并结合患者Ann Ardor分期、血常规、骨髓象、红细胞沉降率（ESR）、铁蛋白的表达水平进行单因素及多因素COX回归分析.结果 88例患者中男50例,女38例,平均年龄54.3 （10～80）岁,其中霍奇金淋巴瘤（HL）11例,非霍奇金淋巴瘤（NHL）侵袭组56例,NHL惰性组21例.TNF-α在对照、HL 、NHL侵袭和NHL惰性组患者组织中的阳性率分别为0、72.72％、67.86％和57.14％,与对照组比较,差异有统计学意义（P值均＜0.05）,各组间比较,差异有统计学意义（P值＜0.05）;TNF-α在血浆中的表达水平分别为（30.17±16.02）、（43.12±15.28）、（40.73±16.65）、（53.18±20.47）ng/L,与对照组比较,差异有统计学意义（P值均＜0.05）,各组间比较,差异有统计学意义（P值＜0.05）.多因素分析结果显示Ann Ardor分期Ⅲ～Ⅳ期、骨髓象异常、ESR＞20 mm/1 h、TNF-α表达阳性是影响患者无病生存和总生存的独立危险因素（P值均＜0.05）.结论 TNF-α作为一个独立的影响因素,可能在淋巴瘤中扮演促进肿瘤发生和发展的角色,直接影响患者的临床治疗和生存预后.

Objective To investigate the levels of tumor necrosis factor-α （TNF-α） in tissue or plasma and its clinical implications in different types of lymphoma.Methods The levels of TNF-α in paraffin tissue or plasma samples were detected by immunohistochemistry or ELISA assay in 88 lymphoma patients and 88 healthy controls.Univariate and multivariate Cox regression analysis were used to identify the correlation between Ann Ardor stage,blood cells count,bone marrow abnormalities,erythrocyte sedimentation rate （ESR）,serum ferritin and TNF-α expression.Results The levels of TNF-α had significant difference in different types of lymphoma （P〈0.05）.High positive and levels in Hodgkin lymphoma [HL,72.72% and （43.12± 15.28） ng/L],aggressive non-HL [NHL,67.86% and （40.73± 16.65） ng/L],and indolent NHL [57.14% and （53.18±20.47） ng/L].Cox regression analysis showed that Ann Ardor stage,bone marrow abnormalities,ESR,and the levels of TNF-α were independent risk factors for lymphoma with poor prognosis.Conclusion As an independent factor,TNF-α may play a role in the development of lymphoma and is an important prognostic factor.