光化性角化病病人皮肤组织Toll样受体7蛋白表达及其临床意义

Expression of TLR7 protein in skin tissue of patients with actinic keratosis and its clinical significance

目的探讨光化性角化病(AK)病人皮肤组织中Toll样受体7(TLR7)蛋白表达及其对AK病人预后的预测效能。方法选取2015年1月至2019年1月四川大学华西医院收集的134例AK病人的皮肤蜡块标本作为观察组,选取同时期收集的129例健康人员的皮肤蜡块标本作为对照组。采用免疫组化法测定两组皮肤组织的TLR7蛋白表达情况,比较两组皮肤组织TLR7蛋白表达水平。对观察组病人随访3年,根据是否发展为皮肤鳞状细胞癌(cSCC)分为癌变组和非癌变组,对比癌变组与非癌变组皮肤组织中TLR7蛋白表达水平,采用单因素分析和logistic回归模型分析AK病人进展为cSCC的影响因素,采用受试者操作特征(ROC)曲线分析皮肤组织TLR7蛋白表达水平对AK病人发生cSCC的预测效能。结果观察组皮肤组织中TLR7蛋白表达水平高于对照组(23.76±3.90比4.95±0.64)(P<0.05);AK病人cSCC发生率为15.67%;癌变组与非癌变组皮肤病史、病程、病理类型比较差异无统计学意义(P>0.05),癌变组年龄高于非癌变组(P<0.05),男性、Fitzpatrick皮肤分型为Ⅰ/Ⅱ型的比例及皮肤组织TLR7蛋白表达量高于非癌变组(P<0.05);高龄、男性、Fitzpatrick皮肤分型为Ⅰ/Ⅱ型、皮肤组织TLR7蛋白高表达均为AK病人癌变发生的独立危险因素(P<0.05),且该模型拟合效果良好(P>0.05);皮肤组织TLR7蛋白表达预测AK病人进展为cSCC的ROC曲线的截断值25.34,灵敏度80.95%,特异度81.42%,ROC曲线下面积0.81,95%CI:(0.74,0.88)。结论AK病人皮肤组织中TLR7蛋白的表达量升高,且是AK病人继发cSCC的独立危险因素,对AK病人的预后具有良好预测效能。

Objective To explore the expression of Toll like receptor 7(TLR7)protein in skin tissue of patients with actinic keratosis(AK)and its predictive efficiency on prognosis of patients with AK.Methods Skin wax samples of 134 patients with AK collected in West China Hospital of Sichuan University from January 2015 to January 2019 were selected as the study group,and the skin wax samples of 129 healthy people collected at the same time were selected as the control group.The expressions of TLR7 protein in skin tissues of the two groups were measured by immunohistochemistry,and the expression levels of TLR7 protein in skin tissues of the study group and the control group were compared.The patients in the study group were followed up for 3 years and divided into cancerous group and non-cancerous group according to whether AK developed into cutaneous squamous cell carcinoma(cSCC)or not.The expression levels of TLR7 protein in skin tissue of cancerous group and non-cancerous group were compared.The influencing factors of cSCC in patients with AK were analyzed by univariate analysis and logistic regression model.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficiency of TLR7 protein expression in skin tissue for the occurrence of cSCC in patients with AK.Results The expression of TLR7 protein in skin tissue of the study group was higher than that of the control group(23.76±3.90 vs.4.95±0.64)(P<0.05).The incidence of cSCC in patients with AK was 15.67%.There was no significant difference in history of skin disease,course of disease and pathological type between cancerous group and non-cancerous group(P>0.05).The age of patients in cancerous group was higher than that of patients in non-cancerous group(P<0.05),and the proportion of male and Fitzpatrick skin type of I/Ⅱand the expression of TLR7 protein in skin tissue were higher than those of non-cancerous group(P<0.05).Advanced age,male,Fitzpatrick skin type ofⅠ/Ⅱand high expression of TLR7 protein in skin were independent risk factors for the occurrence of cSCC in AK patients(P<0.05),and the fitting effect of the model was good(P>0.05).The cut-off value of ROC curve for predicting poor prognosis of AK patients by TLR7 protein expression in skin was 25.34,the sensitivity was 80.95%,the specificity was 81.42%,the area under ROC curve was 0.81,and the 95%CI:(0.74,0.88).Conclusion The expression of TLR7 protein in skin tissue of AK patients is higher,which is an independent risk factor for the occurrence of cSCC in patients with AK,and it has good predictive efficiency on the prognosis of patients with AK.