IL-23/IL-17轴与直肠癌根治术后患者肠功能的相关性

Correlation between interleukin-23/interleukin-17 axis and intestinal function in patients with rectal cancer after radical resection

目的探讨白细胞介素(IL)-23/IL-17轴与直肠癌根治术后患者肠功能恢复的关系。方法回顾性分析2017年1月至2019年12月海南西部中心医院收治的完成直肠癌根治术及随访的81例直肠癌患者病历资料,参照纪念斯隆-凯特林癌症中心(MSKCC)肠道功能问卷评估患者术后3个月肠功能恢复状况并将患者分为恢复良好组和恢复不良组,采集患者基线资料,检测并比较IL-23、IL-17水平,分析IL-23/IL-17轴与直肠癌根治术后患者肠功能恢复的关系。结果81例直肠癌根治术后患者有59例肠功能恢复良好,22例恢复不良。恢复不良组患者血清IL-6、IL-17、IL-23水平高于恢复良好组,差异有统计学意义(P<0.05)。血清IL-17、IL-23、IL-6水平增高是直肠癌根治术后患者肠功能恢复不良的影响因素(OR>1,P<0.05),其中IL-17、IL-23的影响更大(OR=1.762、1.709)。术后肠功能(MSKCC评分)与IL-23、IL-17水平呈负相关(r=-0.666、-0.614,P<0.05),IL-23水平与IL-17呈正相关(r=0.752,P<0.05)。血清IL-23、IL-17单独及联合检测预测直肠癌根治术后患者肠功能不良风险的受试者工作特征曲线下面积为0.888(95%CI:0.809~0.967)、0.929(95%CI:0.871~0.967)及0.948(95%CI:0.893~0.999),均有较好的预测价值,IL-23、IL-17单独预测的最佳临界值分别为50.025、60.755 pg/mL。结论直肠癌根治术后患者血清IL-17、IL-23水平增高,提示患者可能存在术后肠功能恢复不良高风险,动态监测直肠癌患者围术期血清IL-17、IL-23水平,可能对患者术后肠功能恢复不良风险预测,指导制订早期干预计划,以及促进患者肠功能恢复具有积极意义。

Objective To investigate the relationship between the interleukin(IL)-23/IL-17 axis and the recovery of intestinal function in patients after radical resection of rectal cancer.Methods The clinical data of 81 patients with rectal cancer who underwent radical resection and were followed up in Hainan Western Central Hospital from January 2017 to December 2019 were retrospectively analyzed.According to the memorial Sloan Kettering Cancer Center(MSKCC)intestinal function questionnaire,the recovery of intestinal function in 3 months after operation was evaluated,and the patients were divided into the good recovery group and the poor recovery group.Results In 81 patients with rectal cancer after radical resection,59 patients recovered well in intestinal function and 22 patients had poor recovery.The levels of serum IL-6,IL-17 and IL-23 in the poor recovery group were higher than those in the good recovery group,and the difference was statistically significant(P<0.05)。The increased levels of serum IL-17,IL-23 and IL-6 were the factors affecting the poor recovery of intestinal function in patients after radical resection of rectal cancer(OR>1,P<0.05),among which IL-17 and IL-23 had more influence large(OR=1.762,1.709).Postoperative intestinal function(MSKCC score)was negatively correlated with IL-23 and IL-17 levels(r=-0.666,-0.614,P<0.05),and IL-23 level and IL-17 were positively correlated(r=0.752,P<0.05).The area under the receiver operating characteristic curve of serum IL-23 and IL-17 single and combined detection to predict the risk of intestinal dysfunction after radical rectal cancer were 0.888(95%CI:0.809-0.967)and 0.929(95%CI:0.871-0.967)and 0.948(95%CI:0.893-0.999),both of which had good predictive value.The best cut-off values for IL-23 and IL-17 alone were 50.025 and 60.755 pg/mL,respectively.Conclusion Serum IL-17 and IL-23 levels increase in patients after radical resection of rectal cancer,suggesting that patients may have a high risk of poor postoperative intestinal function recovery,dynamic monitoring of serum IL-17 and IL-23 levels in patients with rectal cancer during the perioperative period may have positive significance in predicting the risk of poor intestinal function recovery after surgery,guiding the formulation of early intervention plans,and promoting the recovery of intestinal function in patients.