外周血Treg/Th17细胞免疫失衡与儿童急性淋巴细胞白血病危险度的关系及对预后的评估价值研究

Study on relationship between immune imbalance of Peri Pheral blood Treg/Th17cells and risk of acutelym Phoblastic leukemia in children and its prognostic value

目的 分析外周血Treg/Th17细胞免疫失衡与儿童急性淋巴细胞白血病危险度的关系及对预后的评估价值。方法 选择2016年1月-2018年12月新疆医科大学第一附属医院儿内一科收治的110例急性淋巴细胞白血病患儿作为观察组,另选2016年1月-2018年12月110例健康体检儿作为对照组。观察组患儿根据疾病危险程度分为低危组、中危组和高危组,根据治疗反应分为无事件组和预后不良组。检测以上分组患儿初诊时外周血Treg细胞和Th17细胞比例及Treg/Th17比值在低危组、中危组和高危组,无事件生存组和预后不良组中的差异性。采用ROC曲线分析外周血Treg/Th17比值对预后不良的预测效能。结果与对照组比较,观察组外周血Treg细胞比例升高,Th17细胞比例降低,Treg/Th17比值升高,差异均有统计学意义(P<0.05);儿童急性淋巴细胞白血病危险度不同,外周血Treg细胞比例、Th17细胞比例、Treg/Th17比值三者在低危组、中危组和高危组中差异均有统计学意义(P<0.05);经多因素Logistic回归分析,外周血Treg细胞比例、Th17细胞比例及Treg/Th17比值均是儿童急性淋巴细胞白血病预后不良的独立预测因素(P<0.05);经ROC曲线分析,外周血Treg/Th17比值预测儿童急性淋巴细胞白血病预后不良的AUC为0.912。结论 急性淋巴细胞白血病患儿初诊时外周血Treg/Th17细胞免疫失衡增大,其中外周血Treg/Th17比值与病情危险度呈正性关联,其预测预后不良的效能较好。

Objective To analyze the relationship between the immune imbalance of peripheral blood Treg/Th17 cells and the severity of acute lymphoblastic leukemia in children and its prognostic value.Methods A total of 110 children with acute lymphoblastic leukemia admitted to the hospital from January 2016 to December 2018 were selected as the observation group, and 110 healthy children who underwent the physical examination from January 2016 to December 2018 were selected as the control group. Observation group was divided into low risk group, medium risk group and high risk group according to the disease risk degree, and divided into no event group and poor prognosis group according to the treatment response. The ratio of peripheral blood Treg cells to Th17 cells and the ratio of Treg/Th17 in the low-risk group, the medium-risk group and the high-risk group, the event-free survival group and the poor prognosis group were detected. ROC curve was used to analyze the prognostic efficacy of peripheral blood Treg/Th17 ratio for poor prognosis. Results Compared with the control group, the proportion of peripheral blood Treg cells in the observation group were increased, the proportion of Th17 cells were decreased, and the ratio of Treg/Th17 was increased, with statistical significance(P<0. 05). With the increasing of the severity of acute lymphoblastic leukemia in children, the proportion of peripheral blood treg cells were increased, the proportion of Th17 cells were decreased, and the ratio of Treg/Th17 was increased, and the differences among the three groups were statistically significant(P<0. 05). Multivariate Logistic regression analysis showed that the proportion of Treg cells, Th17cells and Treg/Th17 ratio in peripheral blood were independent predictors of the poor prognosis in children with acute lymphoblastic leukemia(P<0. 05). According to ROC curve analysis, the AUC of Treg/Th17 ratio in peripheral blood predicting poor prognosis in children with acute lymphoblastic leukemia was 0. 912. Conclusion The immune imbalance of Treg/Th17 cells in the peripheral blood of children with acute lymphoblastic leukemia were increased at the first diagnosis, and the ratio of Treg/Th17 in the peripheral blood was positively correlated with the risk of the disease.