TGF-β、GFAP及免疫细胞的表达对恶性胶质瘤术后同期推量调强放疗患者生存情况的影响

Analysis of the effect of serum TGF-beta,GFAP and the expression of immune cells on the survival rate of patients with malignant glioma after simultaneous intensity modulated radiotherapy

目的探究血清转化生长因子β(TGF-β)、血清胶质纤维酸性蛋白(GFAP)及免疫细胞的表达对恶性胶质瘤术后同期推量调强放疗患者生存情况的影响。方法采用回顾性研究方法,选取2015年2月至2017年2月在内蒙古医科大学附属医院神经外科诊治的Ⅲ级脑胶质瘤80例患者术后同期推量调强放疗进行研究。肉眼观察病灶完全切除40例、部分切除40例。检测患者在术前、术后、同期推量调强放疗后血清TGF-β、GFAP、IL6、IL8、IL10和TNF-α表达水平。根据复查时头颅增强CT颅内病灶变化和3年内随访情况,比较两组患者近期疗效和远期疗效。TGF-β、GFAP、IL6、IL8、IL10和TNF-α含量比较采用t检验,各时间段比较采用方差分析。结果患者近期疗效总有效率为77.50% ,完全切除(85.00% )和部分切除(70.00% )有效率差异无统计学意义。患者随着时间的延长生存率逐渐降低,患者肿瘤彻底切除同期推量调强放疗后远期生存率高(P_(2年)=0.0441,P_(3年)=0.0322)。病灶切除越彻底近期疗效(u=2.1993,P=0.0279)和远期疗效(u=4.6247,P=0.0042)越好。部分切除患者术前、术后及同期推量调强放疗后TGF-β[(51.47±10.88)ng/L,(33.16±13.08)ng/L,(21.92±8.79)ng/L,F=6.3135,P=0.0452]、GFAP[(83.59±81.35)ng/L,(57.61±82.33)ng/L,(21.05±35.69)ng/L,F=8.0315,P=0.0236]、IL6[(14.37±4.62)ng/L,(14.05±4.51)ng/L,(12.11±3.42)ng/L,F=9.9532,P=0.0152]、IL8[(44.51±4.97)ng/L,(30.53±4.60)ng/L,F=5.9128,P=0.0356]、IL10[(142.32±26.36)ng/L,(70.02±27.80)ng/L,F=6.7482,P=0.0275]和TNF-α[(43.30±4.01)ng/L,(32.16±3.07)ng/L,F=6.2143,P=0.0281]均降低。完全切除患者同期推量调强放疗后血清TGF-β、GFAP、IL6、IL8、IL10和TNF-α含量与部分切除患者对比差异均有统计学意义(P均<0.05),肿瘤切除越彻底下降越明显。结论恶性胶质瘤术后同期推量调强放疗患者血清TGF-β、GFAP及免疫细胞表达水平越低,患者治疗疗效和生存率越好。血清TGF-β、GFAP和免疫细胞表达水平可有效判断恶性胶质瘤患者术后同期推量调强放疗后的疗效和预后。

Objective To investigate the effect of serum TGF-β, GFAP and expression of immune cells on the survival of patients with malignant glioma after simultaneous intensity modulated radiotherapy during the same period. Methods 80 grade III glioma patients who received postoperative simultaneous intensity modulated radiotherapy in Neurosurgery Department in the Affiliated Hospital of Inner Mongolia Medical University between February, 2015 and February, 2017 were retrospectively studied. There were 40 cases of complete removal of the lesion and 40 cases of partial resection. The levels of serum TGF-β, GFAP, IL-6, IL-8, IL-10 and TNF-α in the patients were measured before, after the operation and after simultaneous intensity modulated radiotherapy. The short-term effect and long-term effect of the two groups were compared according to the intracranial lesion changes by enhanced brain CT and 3-year follow-up results. The comparisons of TGF-β, GFAP, IL-6, IL-8, IL-10 and TNF-α levels were completed by t test, and the comparisons among different periods were completed by analysis of variance. Results The total short-term effective rate was 77.50 % , and there was no significant difference between the complete resection （85 % ） and the partial resection （70 % ） patients （P 〉 0.05）. With the prolongation of time, the survival rate of the patients decreased gradually. The long-term survival rate of patients underwent radical resection and simultaneous intensity modulated radiotherapy was higher （P2 = 0.0441, P3 = 0.0322）. The more thoroughly resection was, the better short-term effect （u = 2.1993, P = 0.0279） and long- term effect （u =4.6247, P = 0.0042） were. TGF-β [（51.47±10.88） ng/L, （33.16± 13.08） ng/L, （21.92±8.79） ng/L, F = 6.3135, P = 0.0452], GFAP [（83.59±81.35） ng/L, （57.61 ±82.33） ng/L, （21.05±35.69） ng/L, F = 8.0315, P = 0.0236], IL-6[（14.37±4.62） ng/L, （14.05±4.51） ng/L, （ 12.11 ±3.42） ng/L, F = 9.9532, P = 0.0152], IL-8 [ （44.51±4.97） ng/L, （30.53±4.60） ng/L, F = 5.9128, P = 0.0356], IL-10[ （142.32±26.36） ng/L, （70.02±27.80） ng/L, F = 6.7482, P = 0.0275] and TNF-ct[ （43.30±4.01） ng/L, （32.16±3.07） ng/L, F = 6.2143, P = 0.0281] before, after operation and after simultaneous intensity modulated radiotherapy were decreased in partial resection patients. Serum TGF-β, GFAP, IL-6, IL-8, IL-10 and TNF-α levels in complete resection patients after simultaneous intensity modulated radiotherapy were statistically different from partial resection patients （P all 〈 0.05 ）. The more thoroughly the resection was, the more obvious the decrease was. Conclusion The levels of serum TGF-β, GFAP and immune cells in patients with malignant glioma after simultaneous intensity modulated radiotherapy were significantly lower than those in the control group, and the therapeutic effect and survival rate were better. The levels of serum TGF-β, GFAP and the expression of immune cells can effectively indicate the curative effect and prognosis of patients with malignant glioma after simultaneous intensity modulated radiotherapy.