原发性肝癌患者TACE术后Th1/Th2细胞因子、VEGFR水平变化及其临床意义

Changes and Clinical Significance of Th1/Th2 Cytokines and VEGFR After TACE in Patients with Primary Liver Cancer

目的探究原发性肝癌患者经肝动脉插管化疗栓塞术(TACE)治疗后Th1/Th2细胞因子、血管内皮生长因子受体(VEGFR)水平变化及其临床意义。方法选取接受TACE术治疗的原发性肝癌患者92例,根据治疗效果将完全缓解、部分缓解者纳入有效组(n=50),将疾病进展、疾病稳定者纳入无效组(n=42)。比较2组患者的一般临床资料及术前、术后血清Th1/Th2细胞因子水平[白介素-2(IL-2)、白介素-4(IL-4)、白介素-18(IL-18)]、VEGFR水平变化,采用Logistic回归模型进行分析上述指标与疗效的相关性,并通过ROC曲线预测分析上述指标术后水平对疗效的预测效能,比较各指标术后不同水平患者的无进展生存期差异。结果术后2组患者的IL-2、IL-4和VEGFR均较术前下降,且有效组显著低于无效组(P<0.05);术后2组患者的IL-18均较术前显著上升,且有效组显著高于无效组(P<0.05)。IL-2、IL-4、IL-18和VEGFR均与临床疗效具有显著相关性(P<0.05),ROC曲线显示,IL-2、IL-18、VEGFR的AUC值均有评估价值(P<0.05),而IL-4的ROC曲线AUC值评估价值不高(P>0.05)。IL-2、VEGFR高水平患者平均无进展生存期显著短于IL-2、VEGFR低水平患者(P<0.05),IL-18低水平患者无进展生存期显著短于IL-18高水平患者(P<0.05)。结论原发性肝癌患者在TACE术后Th1/Th2细胞因子免疫平衡得以纠正,VEGFR水平表现出下降,其中血清IL-2与VEGFR水平均与疗效及生存期密切相关,可在临床疗效及预后评估中提供参考。

Objective To explore the changes and clinical significance of Th1/Th2 cytokines and vascular endothelial growth factor receptor(VEGFR)in patients with primary liver cancer after transcatheter arterial chemoembolization(TACE).Methods 92 patients with primary liver cancer who received TACE treatment were selected.According to the treatment effect,the patients with complete remission or partial remission were included in effective group(n=50),and the patients with disease progression or disease stability were enrolled as ineffective group(n=42).General clinical data and serum Th1/Th2 cytokines[interleukin-2(IL-2),interleukin-4(IL-4),interleukin-18(IL-18)]and VEGFR before and after surgery were compared between the two groups of patients.Logistic regression model was used to analyze the correlation between the above indicators and efficacy.ROC curve was used to analyze the predictive efficiency of the above indicators after surgery on efficacy,and the differences in progression-free survival time were compared among patients with different levels of postoperative indicators.Results The levels of IL-2,IL-4 and VEGFR after surgery were decreased in both groups compared with those before surgery,and the levels in effective group were significantly lower than those in ineffective group(P<0.05).The level of IL-18 after surgery was significantly increased in both groups compared with that before surgery,and the level in effective group was significantly higher than that in ineffective group(P<0.05).IL-2,IL-4,IL-18 and VEGFR were significantly correlated with clinical efficacy(P<0.05),ROC curves revealed that the AUCs of IL-2,IL-18 and VEGFR had evaluated value(P<0.05),but the evaluated value of AUC of ROC curve of IL-4 was not high(P>0.05).The mean progression-free survival time of patients with high level of IL-2 or VEGFR was significantly shorter than that of patients with low level of IL-2 or VEGFR(P<0.05),and the progression-free survival time of patients with low level of IL-18 was significantly shorter than that of patients with high level of IL-18(P<0.05).Conclusion Immune balance of Th1/Th2 cytokines in patients with primary liver cancer can be corrected after TACE,and VEGFR level is decreased.Serum IL-2 and VEGFR level are closely related to efficacy and survival time,and can provide reference for clinical effi-cacy and prognosis evaluation.