血清MCP-1、IL-6、TNF-α联合检测在脑胶质瘤治疗中的临床价值

Clinical value of serum MCP-1,IL-6 and TNF-αjoint detection in glioma therapy

目的：探讨血清单核细胞趋化蛋白1（MCP-1）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）联合检测在脑胶质瘤治疗中的临床价值。方法：93例脑胶质瘤患者术后肿瘤病理分级为：Ⅰ级21例、Ⅱ级26例、Ⅲ级22例、Ⅳ级24例,将Ⅰ～Ⅱ级设为低级别组,Ⅲ~Ⅳ级设为高级别组,同时选择同期40例健康人设为健康组,观察胶质瘤不同病理分级血清MCP-1、IL-6、TNF-α水平及低级别、高级别胶质瘤手术前后血清MCP-1、IL-6、TNF-α水平。结果 ：（1）胶质瘤病理分级Ⅰ～Ⅳ及健康组血清MCP-1、IL-6、TNF-α水平两两比较显示差异均有统计学意义（P〈0.05）。各指标表达水平从高到低分别为：MCP-1：健康组〉Ⅰ级〉Ⅱ级〉Ⅲ级〉Ⅳ级,IL-6：Ⅳ级〉Ⅲ级〉Ⅱ级〉Ⅰ级〉健康组,TNF-α：Ⅰ级〉Ⅱ级〉Ⅲ级〉Ⅳ级〉健康组。person分析结果显示,胶质瘤病理分级与血清MCP-1、IL-6、TNF-α水平水平均存在明显相关（P〈0.05）,相关系数分别为-0.881、0.783、-0.814。（2）受试者工作曲线（ROC）区分脑胶质瘤低级别与高级别的效力,MCP-1、IL-6、TNF-α的曲线下面积（AUC）分别为0.853、0.783、0.802,敏感度分别为92.37%、83.56%、87.32%,特异度分别为88.37%、88.42%、84.26%,准确率分别为80.74%、71.98%、75.78%。3种指标联合评估时,AUC为0.956,敏感度、特异度、准确率分别为97.45%、98.32%、95.77%。（3）术后14d,低级别组和高级别组MCP-1较本组术前明显上升而IL-6、TNF-α均明显下降（P〈0.05）,其中低级别组各指标与健康组已无明显差异（P〉0.05）,高级别组MCP-1仍低于健康组而IL-6、TNF-α仍高于健康组（P〈0.05）。结论：血清MCP-1、IL-6、TNF-α表达水平与脑胶质瘤病理分级存在明显相关,联合检测可明显提高低级别/高级别脑胶质瘤的早期诊断能力,同时或可用于评价手术治疗效果。

Objective： To discuss the clinical value of serum monoeyte chemoattractant protein （MCP-1）, interleukin-6 （IL-6） and tumor necrosis factor-α（TNF-α） joint detection in glioma therapy. Methods： A total of 93 cases of glioma patients were ranked into grade I （21 cases）, grade Ⅱ （26 cases）, gradeⅢ（22 cases） and grade IV （24 cases） based on their postop- erative tumor pathologies. Grade I and Ⅱ were set as the low grade group, grade Ⅲ and IV were set as the high grade group, meanwhile, 40 cases of healthy people in the corresponding period were chose and set as the healthy group. Observation： Levels of serum MCP-1, IL-6 and TNF-α in different glioma pathologic grades; Q Levels of serum MCP-1, IL-6 and TNF-α in low and high grades of glioma before and after operation. Results： （!） Serum MCP-1, IL-6 and TNF-α levels in glioma patholo- gy grades I-Ⅳ and healthy group were compared in pairs, the differences showed with statistical significance （P〈0.05）. In- dexes expressed levels showing from high to low were： MCP-1 healthy group〉 grade Ⅰ〉grade Ⅱ 〉grade Ill〉grade IV ;IL- 6 grade Ⅳ〉gradeⅢ〉grade Ⅱ 〉grade I 〉 healthy group; TNF-Ⅲ grade I 〉grade Ⅱ 〉 grade Ⅲ〉grade IV〉healthy group. Analysis of person result showed an obvious and positive correlation on grading of glioma pathology and serum MCP-1, IL-6 and TNF-a levels （P〈0.05）, the correlation coefficients were -0.881, 0.783 and -0.814; （2） Receiver operating characteris- tic （ROC） was used to distinguish efficacy of low grade and high grade glioma, area under curve （AUC） of MCP-1, IL-6 and TNF-α were 0.853, 0.783, 0.802, sensitivities were 92.37 %, 83.56%, 87.32% Speeificities were 88.37%, 88.42%, 84.26% Accuracy rates were 80.74%, 71.98%, 75.78%. When 3 indexes were combined for evaluation, AUC appeared to be 0.956, sensitivity, specificity and accuracy rate were 97.45%, 98.32%, 95.77%. 14 days after operation, MCP-1 levels in low grade and high grade group were obviously increased more than before operation, but IL-6 and TNF-α were obviously decreased （P〈0.05）.There was no obvious difference between low grade group and healthy group when compared each index （P〉0.05）, and MCP-1 in high grade group still lower than healthy group, IL-6 and TNF-α were still higher than healthy group （P〈0. 05）. Conclusions： An obvious correlation exists between the expression levels of serum MCP-1, IL-6, TNF-α and the glioma pathology grades, the joint detection could significantly enhance the early diagnosis ability of low grade/high grade glioma, and it might he used to evaluate the therapeutic effects of the operation.