基于决策曲线分析血清白细胞介素-12、转化生长因子-β1水平对尖锐湿疣患者5-氨基酮戊酸光动力疗法治疗后复发的影响

The analysis on influence of serum IL-12 and TGF-β1 levels on recurrence after 5-aminolevulinic acid photodynamic therapy in patients with condyloma acuminatum based on decision curve

目的基于决策曲线分析血清白细胞介素-12(IL-12)、转化生长因子-β1(TGF-β1)水平对尖锐湿疣(CA)患者5-氨基酮戊酸(ALA)光动力(PDT)疗法治疗后复发的影响。方法选取2019年1月至2020年1月北京大学人民医院诊治的104例接受ALA-PDT疗法治疗的CA患者作为研究对象。入院时,测定患者血清IL-12、TGF-β1水平,全部患者均于治疗完成后接受1年随访,依据随访期间是否复发分为复发组、未复发组,比较两组基线资料和入院时血清IL-12、TGF-β1,经Logistic回归分析血清IL-12、TGF-β1水平对CA患者ALA-PDT疗法治疗后复发的影响,绘制决策曲线分析入院时血清IL-12、TGF-β1水平预测CA患者ALA-PDT疗法治疗后复发的净受益率。结果经ALA-PDT疗法治疗后,随访1年,结果显示,104例CA患者中,有41例复发,复发率为39.42%;复发组皮损数量多于未复发组,人乳头瘤病毒(HPV)多重感染占比大于未复发组,IL-12低于未复发组,TGF-β1高于未复发组,差异具有统计学意义(P<0.05);Logistic回归分析结果显示,皮损数量、HPV感染情况、TGF-β1均可能是CA患者ALA-PDT疗法治疗后复发的影响因素(OR>1,P<0.05);IL-12可能是CA患者ALA-PDT疗法治疗后复发的保护因素(OR<1,P<0.05);绘制决策曲线,结果显示,当高风险阈值为0.00~0.57时,净受益率大于0,有临床意义,净受益率最大值为0.394;当阈值为0.17~0.71时,联合入院时血清IL-12、TGF-β1水平的预测模型预测CA患者ALA-PDT疗法治疗后复发的净受益率优于单纯IL-12或单纯TGF-β1。结论血清IL-12、TGF-β1水平影响CA患者ALA-PDT疗法治疗后复发,可用于预测CA患者ALA-PDT疗法治疗后复发,且两者联合预测净受益率更高。

Objective To analyze the influence of serum interleukin-12(IL-12) and transforming growth factor-β1(TGF-β1) levels on recurrence after 5-aminolevulinic acid(ALA) photodynamic therapy(PDT) in patients with condyloma acuminatum(CA). Methods 104 CA patients treated with ALA-PDT in People′s Hospital of Peking University from January 2019 to January 2020 were selected as the research subjects. On admission, serum IL-12 and TGF-β1 levels were measured. All patients were followed up for 1 year after treatment, and were divided into recurrence group and non-recurrence group according to whether there was recurrence during the follow-up. Baseline data of and serum IL-12 and TGF-β1 at admission the two groups were compared. Logistic regression was used to analyze the influence of serum IL-12 and TGF-β1 levels on recurrence after ALA-PDT therapy in CA patients, and a decision curve was drawn to analyze the net benefit rate of recurrence after ALA-PDT therapy predicted by serum IL-12 and TGF-β1 levels at admission. Results After treatment with ALA-PDT, 41 of 104 CA patients relapsed, with a recurrence rate of 39.42%. The number of skin lesions in the recurrence group was higher than that in the non-recurrence group, the proportion of multiple infection of human papilloma virus(HPV) was higher than that in the non-recurrence group, IL-12 was lower than that in the non-recurrence group, and TGF-β1 was higher than that in the non-recurrence group, the differences were statistically significant(P<0.05). Logistic regression analysis showed that the number of lesions, HPV infection and TGF-β1 might be the influencing factors of recurrence after ALA-PDT therapy in CA patients(OR>1,P<0.05). IL-12 may be a protective factor for recurrence after ALA-PDT therapy in CA patients(OR<1,P<0.05). The result of decision curve showed that, when the risk threshold was between 0.00 and 0.57, the net benefit rate was greater than 0, which was clinically significant. The maximum net benefit rate was 0.394. When the threshold was 0.17 to 0.71, the combined prediction model of serum IL-12 and TGF-β1 levels at admission for predicting the net benefit rate of recurrence after ALA-PDT therapy in CA patients was better than IL-12 alone or TGF-β1 alone. Conclusions Serum IL-12 and TGF-β1 levels affect recurrence of CA patients after ALA-PDT therapy, and can be used to predict recurrence of CA patients after ALA-PDT therapy, and the net benefit rate predicted by the combined of the two is higher.