摘要
目的探讨腹腔镜下胃肠道肿瘤根治性切除术后患者免疫微环境重塑与预后的关系。方法前瞻性选取2022年1月至2023年12月南平市第一医院收治的120例接受腹腔镜下胃肠道肿瘤根治性切除术患者为研究对象,根据随访结果将患者分为预后不良组(37例)和预后良好组(83例)。收集患者术前和术后的免疫微环境重塑指标,包括CD4^(+)T细胞、CD8^(+)T细胞、CD4^(+)/CD8^(+)比值、白细胞计数(WBC)、中性粒细胞与淋巴细胞比值(NLR)、C反应蛋白(CRP)、IL⁃6、TNF⁃α、PD⁃1、PD⁃L1水平。通过多因素Logistic回归分析,评估免疫微环境重塑指标与术后预后的关系,并比较各项影响因素对预后的预测价值。结果术后,预后不良组CD8^(+)T细胞比率、IL⁃6、TNF⁃α、PD⁃1、PD⁃L1水平显著高于预后良好组,CD4^(+)T细胞比率及CD4^(+)/CD8^(+)比值显著低于预后良好组,差异均有统计学意义(P<005)。多因素Logistic回归分析显示,CD4^(+)/CD8^(+)比值是预后不良的保护因素,IL⁃6、PD⁃1和PD⁃L1是预后不良的危险因素(P<005)。受试者工作特征(ROC)曲线分析结果显示,联合检测CD4^(+)/CD8^(+)比值、IL⁃6、PD⁃1和PD⁃L1具有较高的预后预测价值,AUC为0.876。结论腹腔镜下胃肠道肿瘤根治性切除术后,患者的免疫微环境重塑与预后密切相关。CD4^(+)/CD8^(+)比值、IL⁃6、PD⁃1和PD⁃L1可作为评估患者预后的潜在生物标志物。
Objective To investigate the relationship between immune microenvironment remodeling and prognosis in patients undergoing laparoscopic radical resection of gastrointestinal tumors.Methods A total of 120 patients who underwent laparoscopic radical resection of gastrointestinal tumors at Nanping first hospital between Jan 2022 and Dec 2023 were enrolled.Patients were divided into good prognosis group and poor prognosis group based on postoperative follow-up.Immune microenvironment remodeling indicators,including CD4^(+)T cells,CD8^(+)T cells,the CD4^(+)/CD8^(+)ratio,WBC,NLR,CRP,IL-6,TNF-α,PD-1,and PD-L1,were collected before surgery and at 1 month postoperatively.Multivariate logistic regression analysis was used to assess the relationship between these immune microenvironment remodeling indicators and postoperative prognosis.The predictive value of these factors for prognosis was compared.Results After surgery,the poor prognosis group had significantly higher levels of CD8^(+)T cells,IL-6,TNF-α,PD-1,and PD-L1,and significantly lower levels of CD4^(+)T cells and the CD4^(+)/CD8^(+)ratio compared to the good prognosis group(P<0.05).Multivariate logistic regression analysis indicated that the CD4^(+)/CD8^(+)ratio was a protective factor for poor prognosis,while IL-6,PD-1,and PD-L1 were risk factors(P<0.05).ROC curve analysis showed that the combined detection of the CD4^(+)/CD8^(+)ratio,IL-6,PD-1,and PD-L1 had high predictive value for prognosis,with AUC of 0.876.Conclusion Immune microenvironment remodeling is closely related to prognosis following laparoscopic radical resection of gastrointestinal tumors.The CD4^(+)/CD8^(+)ratio,IL-6,PD-1,and PD-L1 may serve as potential biomarkers for assessing patient prognosis.
作者
陈军
郭毅蓉
上官少华
黄兴
CHEN Jun;GUO Yirong;SHANGGUAN Shaohua;HUANG Xing(Department of Gastrointestinal Surgery,The First Hospital of Nanping City,Fujian Province,Fuzhou 353000,China)
出处
《转化医学杂志》
2024年第6期825-829,共5页
Translational Medicine Journal
基金
南平市科技计划项目(N2023J021)。
关键词
免疫微环境重塑
腹腔镜手术
胃肠道肿瘤
预后
Immune microenvironment remodeling
Laparoscopic surgery
Gastrointestinal tumors
Prognosis
作者简介
陈军,本科,副主任医师。主要从事胃肠肿瘤方向研究;通讯作者:黄兴,E⁃mail:523491768@qq.com。
