胸部恶性肿瘤放疗前后外周血细胞因子的检测及临床意义-现代医学

胸部恶性肿瘤放疗前后外周血细胞因子的检测及临床意义

单位：1. 南京医科大学康达学院附属涟水人民医院检验科, 江苏涟水 223400;
2. 南京医科大学康达学院附属涟水人民医院肿瘤科, 江苏涟水 223400

关键词：恶性肿瘤放疗辅助性T细胞型细胞1因子辅助性T细胞2型细胞因子放射性肺损伤

分类号：R446.63

出版年·卷·期（页码）：2024·52·第一期（77-82）

摘要：

目的：通过检测胸部恶性肿瘤患者放疗前后外周血中白细胞介素-2(IL-2)、IL-4、IL-6、IL-10、肿瘤坏死因子-α(TNF-α)、干扰素-γ(INF-γ) 的含量水平变化，探讨其临床意义。方法：按照严格的纳入和排除标准，选取南京医科大学康达学院附属涟水人民医院2021年10月—2023年5月收治的50例胸部恶性肿瘤患者作为肿瘤组，选用同期查体健康者30例为对照组。采集肿瘤组放射治疗前、放疗期间(放疗3周后)、放疗结束时、放疗结束后1个月和4个月，5个观察点的外周静脉血，运用流式细胞术检测患者放疗前后外周血中IL-2、IL-4、IL-6、IL-10、TNF-α、INF-γ的含量并与对照组相比。结果：与对照组相比，肿瘤组外周静脉血IL-2、IFN-γ的浓度水平明显低于对照组，IL-6和TNF-α的水平明显高于对照组，差异均有统计学意义(P＜0.05)；IL-4、IL-10的浓度水平在两组中比较差异无统计学意义(P＞0.05)。放疗期间肿瘤组外周血TNF-α自放疗后开始上升，至放疗结束后1个月升至最高，显著高于放疗前(P＜0.05)，然后逐渐下降，至放疗结束后4个月与放疗前相比无显著差异(P＞0.05)；肿瘤组外周血IL-6自放疗后开始上升，放疗结束时达高峰后开始下降，放疗结束后4个月与放疗前相比无显著差异(P＞0.05)。放射性肺损伤(RILI)组与非RILI组比较，IL-6和TNF-α水平在放疗的不同时期RILI组均升高；在放疗不同时期两组IL-2、IL-4、IL-10和IFN-γ水平差异无统计学意义。结论：放疗会不同程度地影响胸部肿瘤患者外周血细胞因子的水平，放疗过程中监测细胞因子的浓度可为机体的免疫危机状态以及肺的RILI提供预警，为放疗过程中实施早期的免疫预防和纠正措施提供理论依据。

Objective: To investigate the clinical significance of Interleukin 2(IL-2), IL-4, IL-6, IL-10, tumor necrosis factor-α(TNF-α) and interferon-γ(INF-γ) in peripheral blood of patients with thoracic malignant tumor before and after radiotherapy. Methods: According to the strict inclusion and exclusion criteria, 50 patients with thoracic malignant tumor admitted to Lianshui People's Hospital from October 2021 to May 2023 were selected as the tumor group, and 30 healthy patients in the same period were selected as the control group. Peripheral venous blood was collected from 5 observation points in the tumor group before and during radiotherapy(3 weeks after radiotherapy), at the end of radiotherapy, 1 month and 4 months after radiotherapy, and the contents of IL-2, IL-4, IL-6, IL-10, TNF-α and INF-γ in peripheral blood of patients before and after radiotherapy were detected by flow cytometry and compared with those of the controls group. Results: Compared with the control group, the levels of IL-2 and IFN-γ in peripheral blood of tumor group were significantly lower than those of the healthy group, and the levels of IL-6 and TNF-α were significantly higher than those of healthy group, with significant statistical differences(P<0.05). The levels of IL-4 and IL-10 were not significantly different between the two groups(P＞0.05). During the period of radiotherapy, peripheral blood TNF-α in the tumor group began to increase after radiotherapy, and reached the highest level 1 month after radiotherapy, which was significantly higher than before radiotherapy(P<0.05), and then gradually decreased, and no significant difference was found 4 months after radiotherapy compared with before radiotherapy(P＞0.05). In the tumor group, IL-6 in peripheral blood began to increase after radiotherapy, reached a peak at the end of radiotherapy and began to decrease, and there was no significant difference 4 months after radiotherapy compared with before radiotherapy(P＞0.05). There were significant differences in the levels of IL-6 and TNF-α in peripheral blood between the radiation induced lung injury(RILI) group and the non-RILI group at different periods of radiotherapy, and the levels of IL-6 and TNF-α increased in the RILI group at different periods of radiotherapy. There were no significant differences in the levels of IL-2, IL-4, IL-10 and IFN-γ between the two groups at different periods of radiotherapy. Conclusion: Radiotherapy will affect the levels of peripheral blood cytokines in patients with thoracic tumors to varying degrees. Monitoring the concentration of cytokines during radiotherapy can provide early warning for the immune crisis state of the body and lung radiation damage, and provide theoretical basis for the implementation of early immune prevention and corrective measures during radiotherapy.

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