乳腺癌根治术围术期血清GH和IGF-I水平与其免疫功能的关系及其联合预测预后

Relationship between Serum GH and IGF-I Levels and Immune Function During Perioperative Period of Radical Mastectomy for Breast Cancer and Their Combined Prediction of Survival Prognosis

目的探讨乳腺癌根治术围术期血清生长激素(GH)和胰岛素样生长因子-I(IGF-I)水平的与其免疫功能的关系及其联合预测生存预后。方法选取乳腺癌根治术患者152例,采用酶联免疫吸附法(ELISA),检测血清GH、IGF-I和免疫球蛋白A(Ig A)、免疫球蛋白A(Ig G)、免疫球蛋白A(Ig M)水平,随访3年,依据生存情况分为生存组(n=86例)和死亡组(n=66例),采用Pearson相关性分析法分析,血清GH、IGF-I与Ig A、Ig G、Ig M的关系,采用ROC曲线分析血清GH、IGF-I联合预测生存预后的效能,统计分析所有患者术前、术后血清GH、IGF-I、Ig A、Ig G、Ig M水平和生存预后情况。结果患者术后血清GH、IGF-I、Ig A、Ig G、Ig M水平明显低于术前,差异有统计学意义(P<0.05);Pearson相关性分析法结果显示,血清GH、IGF-I与Ig A、Ig G、Ig M呈正相关(P<0.05);生存组患者术后血清GH、IGF-I水平明显高于死亡组,差异有统计学意义(P<0.05);ROC曲线结果显示,GH以3.50 ng/ml为分界值、IGF-I以130 ng/ml为分界值时,其联合预测生存预后的敏感度、特异度、准确度分别为93.94%、93.02%、93.42%,与实际结果基本相同,差异无统计学意义(P>0.05)。结论乳腺癌根治术患者围术期血清GH、IGF-I水平可能与其术后免疫功能抑制状态发生有关,术后联合检测二者水平预测患者的生存预后具有良好的敏感性、特异性和准确性,值得临床作进一步推广。

Objective To discuss the relationship and its joint survival prognosis between breast cancer radical perioperative serum growth hormone（ GH）,insulin-like growth factor I（ IGF-I） level and the immune function. Methods 152 patients undergoing radical mastectomy were selected for the detection of serum GH,IGF-I,and immunoglobulin A（ IgA） by enzymelinked immunosorbent assay（ ELISA）. Immunoglobulin A（ IgG） and immunoglobulin A（ IgM） levels were followed up for 3 years. Survival was divided into survival group（ n = 86） and death group（ n = 66） according to survival conditions. Pearson correlation analysis was used. Analysis of serum GH,IGF-I and IgA,IgG,IgM relationship,the use of ROC curve analysis of serum GH,IGF-I combined to predict the efficacy of survival prognosis,statistical analysis of preoperative and postoperative serum GH,IGF-I,IgA,IgG,IgM levels,and survival outcomes. Results Postoperative serum GH,IGF-I,IgA,IgG,IgM levels were significantly lower than before surgery,the difference was statistically significant（ P〈0. 05）; Pearson correlation analysis showed that serum GH,IGF-I and IgA,There was a positive correlation between IgG and IgM（ P〈0. 05）. The serum levels of GH and IGF-I in the survival group were significantly higher than those of the death group（ P〈0. 05）. The results of ROC curve showed that the sensitivity,specificity,and accuracy of the joint prediction of survival prognosis were 93. 94%,93. 02%,and 93. 42,respectively,when GH was cut off at 3. 50 ng/ml and IGF-I was at a cutoff of 130 ng/ml. %,basically the same as the actual result,the difference was not statistically significant（ P〉0. 05）. Conclusion Perioperative serum GH and IGF-I levels in patients undergoing radical mastectomy may be associated with the occurrence of postoperative immunosuppression. Postoperative combined detection of both levels predicts survival and prognosis of patients with good sensitivity,specificity,and accuracy. It is worthy of clinical promotion.