食管癌和肺癌患者放疗前CD4/CD8比值及总B淋巴细胞预测放射性肺炎的价值

Value of CD4/CD8 ratio and total B lymphocytes before radiotherapy in predicting radiation pneumonitis in patients with esophageal cancer and lung cancer

目的探讨食管癌和肺癌患者放疗前CD4/CD8比值及总B淋巴细胞在预测放射性肺炎(RP)发生中的价值。方法回顾性分析2018年4月至2020年3月在中国科学院合肥肿瘤医院接受放疗的28例食管癌和16例肺癌患者的临床病理资料,根据患者治疗期间及治疗后是否发生RP将患者分为RP组(n=16)和非RP组(n=28)。比较两组患者放疗前CD4/CD8比值及总B淋巴细胞、RP组患者放疗前后CD4/CD8比值及总B淋巴细胞,采用受试者工作特征曲线分析放疗前CD4/CD8比值及总B淋巴细胞预测RP的价值。结果RP组患者放疗前CD4/CD8比值(0.993±0.179)低于非RP组(1.708±0.170),差异有统计学意义(t=2.706,P=0.009);RP组患者血清总B淋巴细胞[(4.409±0.823)%]低于非RP组[(8.153±1.017)%],差异有统计学意义(t=0.986,P=0.015)。RP组患者接受胸部放疗后发生RP时CD4/CD8比值(0.785±0.167)较放疗前(0.993±0.179)降低,但差异无统计学意义(t=1.376,P=0.189);RP组患者接受胸部放疗后发生RP时总B淋巴细胞[(3.487±1.018)%]较放疗前[(4.409±0.823)%]降低,但差异无统计学意义(t=0.804,P=0.433)。CD4/CD8比值、总B淋巴细胞预测RP的临界值分别为0.580、0.357。CD4/CD8比值预测RP的曲线下面积(AUC)为0.802(95%CI为0.653~0.932),敏感性为89.29%,特异性为68.75%;总B淋巴细胞预测RP的AUC为0.694(95%CI为0.483~0.814),敏感性为85.71%,特异性为50.00%;两项联合预测RP的AUC为0.834(95%CI为0.697~0.932),敏感性为81.25%,特异性为89.29%;两项联合检测时AUC分别明显高于单独检测,差异均有统计学意义(Z=1.115,P=0.046;Z=1.992,P=0.026)。结论RP组患者放疗前CD4/CD8比值、总B淋巴细胞低于非RP组患者,血清CD4/CD8比值、总B淋巴细胞在预测接受胸部放疗的恶性肿瘤患者发生RP方面有重要意义。

Objective To investigate the value of CD4/CD8 ratio and total B lymphocytes before radiotherapy in predicting the occurrence of radiation pneumonitis(RP)in patients with esophageal cancer and lung cancer.Methods The clinicopathological data of 28 patients with esophageal and 16 patients with lung cancer undergoing radiotherapy from April 2018 to March 2020 in Hefei Cancer Hospital,Chinese Academy of Sciences were retrospectively analyzed,and the patients were divided into RP group(n=16)and non-RP group(n=28)according to whether RP occurred during and after treatment.The CD4/CD8 ratio and total B lymphocytes before radiotherapy between the two groups,and the CD4/CD8 ratio and total B lymphocytes before and after radiotherapy in the RP group were compared.Receiver operating characteristic curve was used to analyze the value of CD4/CD8 ratio and total B lymphocytes before radiotherapy in predicting RP.Results The CD4/CD8 ratio before radiotherapy in the RP group was significantly lower than that in the non-RP group(0.993±0.179 vs.1.708±0.170),with a statistically significant difference(t=2.706,P=0.009);the total B lymphocytes in the RP group was significantly lower than that in non-RP group[(4.409±0.823)%vs.(8.153±1.017)%],with a statistically significant difference(t=0.986,P=0.015).The CD4/CD8 ratio in the RP group was lower than that before radiotherapy when RP occurred(0.785±0.167 vs.0.993±0.179),with no statistically significant difference(t=1.376,P=0.189).The total B lymphocytes in the RP group was lower than that before radiotherapy when RP occurred[(3.487±1.018)%vs.(4.409±0.823)%],with no statistically significant difference(t=0.804,P=0.433).The critical values of CD4/CD8 ratio and total B lymphocytes predicted RP were 0.580 and 0.357,respectively.The areas under the curve(AUC)of CD4/CD8 for predicting RP was 0.802(95%CI:0.653-0.932),the sensitivity was 89.29%,and the specificity was 68.75%.The AUC of total B lymphocytes for predicting RP was 0.694(95%CI:0.483-0.814),the sensitivity was 85.71%,and the specificity was 50.00%.The AUC of the two combined diagnostic method for RP was 0.834(95%CI:0.697-0.932),the sensitivity and specificity were 81.25%and 89.29%.AUC of the two combined tests was significantly higher than that of the single test,with statistically significant differences(Z=1.115,P=0.046;Z=1.992,P=0.026).Conclusion The CD4/CD8 ratio and total B lymphocytes in the RP group are lower than those in the non-RP group.The CD4/CD8 ratio and total B lymphocytes in the serum are of great significance in predicting the occurrence of RP in patients with malignant tumors receiving chest radiotherapy.