焦虑抑郁情绪对原发性肝癌患者预后及免疫的影响

Effects of anxiety and depressive symptoms on prognosis and immune response in patients with primary liver cancer

目的:探讨焦虑、抑郁情绪对原发性肝癌患者的预后和血浆细胞因子的影响及其作用机制。方法:选取2021年9月至2022年6月在河南中医药大学第一附属医院住院,病程≥6个月经综合介入治疗后达完全缓解(CR)、部分缓解(PR)或病情稳定(SD)的Ⅱ、Ⅲa期原发性肝癌患者90例,依据汉密尔顿焦虑量表(HAMA)和抑郁量表(HAMD)分为焦虑抑郁组(n=38)以及非焦虑抑郁组(n=52)。随访1年,比较两组患者1年疾病控制率(DCR)。经Logistic回归分析与原发性肝癌患者焦虑抑郁情绪相关的危险因素。收集患者血浆,应用高通量悬液芯片技术检测相关细胞因子,分析焦虑抑郁情绪对肝癌患者免疫的影响。结果:无焦虑抑郁组1年DCR显著高于焦虑抑郁组(P<0.05)。中性粒细胞计数、C反应蛋白(CRP)与肝癌患者焦虑抑郁情绪相关(P<0.05)。6个月时,焦虑抑郁组患者MIF、IL-8、CCL25、IL-16、CXCL6、CXCL13、CCL21、CXCL2、CXCL10、CX3CL1、CCL2、CCL3明显高于非焦虑抑郁组,CCL22明显低于非焦虑抑郁组;组内比较,焦虑抑郁组MIF、IL-6、CXCL5、CXCL9、IL-8、CCL23、IL-10、IL-4、CCL2、GM-CSF明显增高,CXCL12降低,而非焦虑抑郁组MIF、IL-6、CXCL5、CXCL9、IL-8、CCL23、IL-10、IL-4、CCL2、GM-CSF含量明显降低,CXCL12含量增高;横向、纵向比较差异明显的交集因子有MIF、IL-8、CCL2。结论:不良情绪影响肝癌患者预后,焦虑抑郁情绪可能通过调控、免疫相关细胞因子、MIF、IL-8、CCL2来影响患者预后。

Objective:To observe the effects of anxiety and depression on the prognosis and cytokines of primary liver cancer(HCC),and to explore its mechanism.Methods:From September 2021 to June 2022,patients with stage II and IIIa primary liver cancer who had achieved Complete Response(CR)or Partial Response(PR)after comprehensive interventional therapy for≥6 menstrual periods were included.According to the Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD),they were divided into anxiety depression group and non-anxiety depression group(exposed group and non-exposed group).The 1-year disease control rate was compared between the two groups.The factors related to anxiety and depression were screened by Logistic regression analysis.Plasma was collected from patients,and relevant cytokines were detected by high-throughput suspension chip technology to analyze the effect of anxiety and depression on immunity in patients with liver cancer.Results:The 1-year disease control rate of the anxiety-depression group was significantly lower than that of the anxiety-depression group(P<0.05).Neutrophil count and C-reactive protein(CRP)were correlated with adverse mood in patients with liver cancer(P<0.05).Cytokine results showed that the plasma cytokine content of MIF,IL-8,CCL25,IL-16,CXCL6,CXCL13,CCL21,CXCL2,CXCL10,CX3CL1,CCL2 and CCL3 in exposed group was significantly higher than that in non-exposed group,and CCL22 was significantly lower than that in non-exposed group.The results showed that MIF,IL-6,CXCL5,CXCL9,IL-8,CCL23,IL-10,IL-4,CCL2 and GM-CSF were significantly increased in exposed group,but significantly decreased in non-exposed group,and CXCL12 was decreased in exposed group but increased in non-exposed group.The intersection factors were MIF,IL-8 and CCL2.Conclusion:Negative emotions affect the prognosis of patients with liver cancer,and the interaction between emotions and inflammatory factors may affect the prognosis of patients through the regulation of MIF,IL-8 and CCL2 immune-related cytokines.