IL-10在急性白血病预后判断中的临床意义研究

The clinical significance of IL-10 in the prognosis of acute leukemia

目的:主要在检测急性髓系白血病患者(AML)的外周血可溶性IL-10血清水平的基础上,分析其在AML患者临床预后判断中的生物学标志物作用。方法:按照国际上统一的FAB诊断标准选择急性髓系白血病患者64例。采用酶联免疫ELISA法检测白血病患者的血清IL-10水平。通过对结果进行ROC曲线分析获得临界值,并以临界值为基准分为大于临界值组和小于临界值组,微小残留病(MRD)采用流式细胞术检测。统计分析血清IL-10水平在预后判断中的作用。结果:AML患者组血清IL-10水平高于正常对照组,分别为86.74±79.16pg/ml和41.87±20.32pg/ml,差异具有统计学意义(t=2.732,P=0.00076)。大于临界值(cut-off)组的平均水平高于小于临界值组,分别为107.20±87.48pg/ml和31.58±9.92pg/ml(t=4.626,P<0.0001)。完全缓解(CR)组低于未获得缓解组(NR),分别为60.31±50.09pg/ml和149.40±99.58pg/ml(t=4.769,P<0.0001)。复发组高于非复发组,分别为112.70±98.83pg/ml和41.55±29.30pg/ml(t=4.293,P<0.0001)。治疗3周后的WBC数量或淋巴细胞数量与血清IL-10水平均没有明显的相关性(r=0.0023,P=0.7118;r=0.005754,P=0.5546),治疗6周后的WBC数量或淋巴细胞数量和血清IL-10水平也没有明显的相关性(r=0.0029,P=0.6924;R=0.0171,P=0.3317)。大于和小于临界值两组的CR率分别为89.65%和54.29%,复发率分别为10.34%和25.71%,差异均无统计学意义(χ^(2)=1.642,P=0.200;χ^(2)=1.710,P=0.191)。小于临界值组的MRD发生率低于大于临界值组,分别为17.24%和57.14%(χ^(2)=4.879,P=0.027)。小于临界值组的NR率也低于大于临界值组,分别为10.34%和42.86%(χ^(2)=4.845,P=0.028)。大于和小于临界值两组的平均无病生存期分别为24.65±23.36个月和47.95±20.45个月,差异具有统计学意义(t=3.191,P=0.0030),血清IL-10水平与无病生存期存在负相关性(r=-0.3021,P=0.0153)。大于或小于临界值两组的3年总生存率分别为16.67%和41.67%,5年生存率分别为16.67%和38.89%,差异均具有显著性(χ^(2)=7.034,P=0.0080;χ^(2)=5.355,P=0.0270)。结论:AML患者血清IL-10的升高,尤其是将血清IL-10水平分为大于或小于临界值两组后,可以作为疗效评估、微小残留病监测和预后判断的血清学指标。

Objective:Based on the detection of peripheral blood soluble IL-10 serum levels in patients with acute myeloid leukemia(AML),to analyze its role as a biomarker in judging the clinical prognosis of patients with AML.Methods:Thirty-seven patients with acute myeloid leukemia were selected according to the internationally unified FAB diagnostic criteria.Serum IL-10 levels in leukemia patients were detected by enzyme-linked immunosorbent assay.The critical value was obtained by ROC curve analysis of the results,and based on the critical value,the patients were divided into groups greater than the critical value and those less than the critical value.Minimal residual disease(MRD)was detected by flow cytometry.Statistical analysis of the role of serum IL-10 level in prognosis judgment.Results:After ROC curve analysis of sample concentrations,patients with acute myeloid leukemia(AML)were divided into two groups according to the cut-off value,greater and less than the cut-off value.The mean levels of serum IL-10 in the groups above and below the cut-off value were 107.20±87.48 pg/ml and 31.58±9.92 pg/ml,respectively,and the difference between the two groups was statistically significant(t=4.626,P<0.0001).The average level of IL-10 in the AML patient group was higher than that in the control group,which were 86.74±79.16 pg/ml and 41.87±20.32 pg/ml,respectively,and the difference was statistically significant(t=2.732,P=0.00076).The complete remission(CR)group was lower than the non-remission group(NR),and the serum IL-10 levels were 60.31±50.09 pg/ml and 149.40±99.58 pg/ml,respectively,and the difference was statistically significant(t=4.769,P<0.0001).The relapse group was higher than the non-recurrence group,and the serum IL-10 levels were 112.70±98.83 pg/ml and 41.55±29.30 pg/ml,respectively,and the difference was statistically significant(t=4.293,P<0.0001).After 3 weeks of treatment,there was no significant correlation between the number of WBC or lymphocyte and serum IL-10 level(r=0.0023,P=0.7118;r=0.005754,P=0.5546).There was no significant correlation between the number of WBC or lymphocyte and serum IL-10 after 6 weeks of treatment(r=0.0029,P=0.6924;r=0.0171,P=0.3317).The CR rates between the two groups were 89.65%and 54.29%,and the recurrence rates were 10.34%and 25.71%,respectively,and the difference was not statistically significant(χ^(2)=1.642,P=0.200;χ^(2)=1.710,P=0.191).The incidence of MRD in the group below the critical value was lower than The ratios of the groups above the critical value were 17.24%and 57.14%,respectively,and the difference was statistically significant(χ^(2)=4.879,P=0.027).The NR rates of the groups below the critical value were also lower than those of the groups above the critical value,10.34%and 42.86%,respectively,the difference was statistically significant(χ^(2)=4.845,P=0.028).The mean disease-free survival of the two groups greater than and less than the critical value were 24.65±23.36 months and 47.95±20.45 months,respectively,and the difference was statistically significant(t=3.191,P=0.0030)Serum IL-10 level was negatively correlated with disease-free survival(r=-0.3021,P=0.0153).The 3-year overall survival rates of the two groups were 16.67%and 16.67%,respectively.41.67%,and the 5-year survival rates were 16.67%and 38.89%,respectively,and the differences were significant(χ^(2)=7.034,P=0.0080;χ^(2)=5.355,P=0.0270).Conclusion:The increase of serum IL-10 in AML patients,especially Serum IL-10 level is divided into two groups that are greater than or less than the critical value,and can be used as a serum index for efficacy evaluation,minimal residual disease monitoring and prognosis judgment.