肺磨玻璃结节患者血清炎症因子及髓源性抑制细胞的表达水平及临床意义

Expression levels and clinical significance of serum inflammatory cytokines andmyeloid-derived suppressor cells in patients with pulmonary ground-glass nodule

    摘要
  • 摘要:
      目的  探究血清炎症因子及外周血髓源性抑制细胞（myeloid-derived suppressor cells，MDSCs）在直径≤1 cm的肺磨玻璃结节（ground-glass nodule，GGN）患者中的表达，分析可能影响肺结节大小及进展的临床指标和意义。
      方法  采用前瞻性研究方法纳入2020年4月至2021年7月就诊于上海中医药大学附属市中医医院肺GGN直径≤1 cm的患者111例，根据肺结节大小分为微小结节组（直径<5 mm）、小结节组（直径为5～10 mm），其中微小结节组36例，小结节组75例。检测各组患者血清炎症因子表达以及外周血髓源性抑制细胞的比例，分析组间差异。后续每半年随访1次，以影像学显示肺GGN直径增大2 mm及以上或出现新的GGN为研究终点，分析可能影响肺GGN进展的危险因素。
      结果  小结节组较微小结节组患者MDSCs的比例升高，差异具有统计学意义（P<0.05），两组间炎症因子白细胞介素-2（interleukin-2，IL-2）、白细胞介素-6（interleukin-6，IL-6）、白细胞介素-8（interleukin-8，IL-8）和肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）表达差异无统计学意义（P>0.05）。两组间肺结节变化率差异无统计学意义（P>0.05）。MDSCs是影响肺GGN进展的危险因素，差异具有统计学意义（P<0.05），根据MDSCs表达水平的截断值进行分组分析，结果显示MDSCs低水平表达组（MDSCs<4.57%）较高水平表达组（MDSCs≥4.57%）疾病稳定期更长，差异具有统计学意义（P=0.001）。
      结论  MDSCs表达水平与肺GGN大小相关，可能是影响肺GGN进展的因素之一。

     

    Abstract:
      Objective  To assess the expression of serum inflammatory cytokines and proportion of peripheral blood myeloid-derived suppressor cells (MDSCs) in patients with ground-glass nodule (GGN) ≤1 cm in diameter and analyze clinical indicators that may affect the size and progression of pulmonary nodules and their clinical significance.
      Methods  This prospective study included 111 patients with pulmonary GGNs ≤1 cm in diameter who were admitted to Shanghai Municipal Hospital of Traditional Chinese Medicine from April 2020 to July 2021. Based on pulmonary nodule size, 36 and 75 patients were assigned into minute nodule (diameter <5 mm) and small nodule (diameter 5–10 mm) groups, respectively. The expression of inflammatory cytokines and proportion of MDSCs were determined, and the differences between the groups were analyzed. Follow-up visits were conducted every 6 months. The study endpoint was an increase in pulmonary GGN diameter of ≥2 mm or the occurrence of new GGNs. Risk factors that could affect the progression of pulmonary GGNs were also analyzed.
      Results  The proportion of MDSCs was higher in the small nodule group than in the minute nodule group, with the difference being significant (P<0.05). Interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) expressions were not significantly different between the two groups (P>0.05). There was no significant difference in the change rate of pulmonary nodules between the two groups (P>0.05). The proportion of MDSCs was a risk factor that affected the progression of pulmonary GGNs, and the difference was statistically significant (P<0.05). Based on the cutoff proportion of MDSCs, the duration of stable disease stage was longer in the low-proportion MDSCs group (MDSCs <4.57%) than in the high-proportion MDSCs expression group (MDSCs≥4.57%), and the difference was statistically significant (P=0.001).
      Conclusions  The proportion of MDSCs is correlated with the size of pulmonary GGNs, which may be one of the factors affecting the progression of pulmonary GGNs.

     

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