乳腺癌术后调强放疗所致放射性皮炎患者T淋巴细胞水平的变化及意义

Changes and Significance of T Lymphocyte Levels by in Patients with Radiation Dermatitis Caused by Base Note Intensive Radiotherapy After Breast Cancer Surgery

目的 了解乳腺癌术后调强放疗所致放射性皮炎患者T淋巴细胞水平的变化及意义。方法 回顾性分析郑州大学附属郑州中心医院2020年1月至2021年12月收治的130例乳腺癌术后接受调强放疗患者的临床资料,依据患者调强放疗期间发生放射性皮炎情况分为放射性皮炎组(55例)和无放射性皮炎组(75例)。记录患者调强放疗所致急性放射性皮炎发生情况。记录患者调强放疗前后外周血CD3^(+)、CD4^(+)、CD8^(+)T细胞表达水平,使用受试者工作特征(ROC)曲线评估其对急性放射性皮炎发生的预测价值。结果 55例感染患者中放射性皮炎Ⅰ度43例(78.18%),Ⅱ度7例(12.73%),Ⅲ度4例(7.27%),Ⅳ度1例(1.82%)。130例患者放疗前外周血CD3^(+)、CD4^(+)细胞水平高于放疗后(P<0.05),CD8^(+)细胞水平低于放疗后(P<0.05)。放射性皮炎组患者放疗前外周血CD3^(+)、CD4^(+)细胞免疫水平低于无放射性皮炎组(P<0.05),CD8^(+)细胞免疫表达水平高于无放射性皮炎组(P<0.05)。重度放射性皮炎组患者放疗前外周血CD3^(+)、CD4^(+)细胞水平低于轻度放射性皮炎组,CD8^(+)细胞水平高于轻度放射性皮炎组(P<0.05)。运用ROC曲线分析得出AUC值分别为0.810、0.752、0.824,均接近1,外周血CD3^(+)、CD4^(+)、CD8^(+)淋巴细胞免疫功能表达更低对乳腺癌术后放疗出现放射性皮炎发生有较高预测价值。结论 乳腺癌患者放疗后T淋巴细胞免疫功能降低,且出现放射性皮炎组患者外周血CD3^(+)、CD4^(+)细胞表达更低。外周血CD3^(+)、CD4^(+)、CD8^(+)细胞表达水平预测乳腺癌术后放疗期间放射性皮炎发生具有较高准确性。

Objective To investigate the changes and significance of T lymphocyte levels by in patients with radiation dermatitis caused by base note intensive radiotherapy after breast cancer surgery.Methods Retrospective analysis was made on the clinical data of 130 patients with breast cancer who received intensity-modulated radiation therapy from January 2020 to December 2021 in Zhengzhou Central Hospital affiliated to Zhengzhou University. According to the radiation dermatitis during IMRT, the patients were divided into radiation dermatitis group(55 cases) and non radiation dermatitis group(75 cases). The incidence of acute radiation dermatitis caused by intensity-modulated radiotherapy was recorded. The expression levels of CD3^(+), CD4^(+), CD8^(+)T cells in peripheral blood of patients before and after intensity-modulated radiotherapy were recorded, and the predictive value of the receiver operating characteristic(ROC) curve for the occurrence of acute radiation dermatitis was evaluated.Results Among the 55 infected patients, 43 cases(78.18%) had radiation dermatitis of gradeⅠ, 7 cases(12.73%) of gradeⅡ, 4 cases(7.27%) of grade Ⅲ, and 1 case(1.82%) of grade Ⅳ. The level of CD3^(+)and CD4^(+)cells in peripheral blood of 130 patients before radiotherapy was higher than that after radiotherapy(P<0.05), and the level of CD8^(+)cells was lower than that after radiotherapy(P<0.05). The level of CD3^(+)and CD4^(+)cell immunity in peripheral blood of patients with radiation dermatitis before radiotherapy was lower than that of patients without radiation dermatitis(P<0.05), and the level of CD8^(+)cell immunity expression was higher than that of patients without radiation dermatitis(P<0.05). The level of CD3^(+)and CD4^(+)cells in peripheral blood of patients with severe radiation dermatitis before radiotherapy was lower than that of patients with mild radiation dermatitis, and the level of CD8^(+)cells was higher than that of patients with mild radiation dermatitis(P<0.05). The ROC curve analysis showed that AUC values were 0.810, 0.752 and 0.824, all close to 1. The lower expression of peripheral blood CD3^(+), CD4^(+)and CD8^(+)lymphocyte immune function had a higher predictive value for the occurrence of radiation dermatitis in postoperative radiotherapy of breast cancer.Conclusion After radiotherapy, the immune function of T lymphocytes in breast cancer patients decreased, and the expression of CD3^(+)and CD4^(+)cells in peripheral blood of patients with radiation dermatitis was lower. The expression levels of peripheral blood CD3^(+), CD4^(+)and CD8^(+)cells have high accuracy in predicting the occurrence of radiation dermatitis during postoperative radiotherapy for breast cancer.