外周血sPD-L1在预测侵袭性非霍奇金淋巴瘤患者预后中的临床价值

摘要

目的 探讨外周血可溶性程序性细胞死亡配体(s PD-L1)在预测侵袭性非霍奇金淋巴瘤(NHL)患者预后中的应用价值.方法 收集112例侵袭性NHL[弥漫大B细胞淋巴瘤(DLBCL)]患者的临床资料,并选择同期来医院体检的40例正常健康人作为对照组.所有对象均采集空腹外周血标本,采用双抗体夹心-酶联免疫吸附法(ABC-ELISA)测定外周血s PD-L1水平,分析其与DLBCL临床病理参数及预后的关系.结果 病例组外周血s PD-L1水平高于对照组(P ＜0.05).NHL国际预后指数(IPI)为高危、Ann Arbor分期为ⅢⅣ期、肿块大小≥10 cm、病理类型为T细胞型、治疗反应为SD+PD的患者血清s PD-L1水平高于IPI指数为低危、Ann Arbor分期为ⅠⅡ期、肿块大小＜10 cm、病理类型为B细胞型、治疗反应为CR+PR的患者(P ＜0.05).高s PD-L1患者生存率(OS)明显低于低s PD-L1患者(P ＜0.05).Cox分析显示:高s PD-L1、Ann Arbor为ⅢⅣ期、病理类型为T细胞型均为导致DLBCL患者预后不良的独立危险因素(P ＜0.05).结论 DLBCL患者外周血s PD-L1呈明显高表达,且其表达水平的变化与患者IPI指数、临床分期、肿块大小、病理类型、治疗反应均存在紧密联系,同时也是影响患者预后的危险因素.%Objective To investigate the value of soluble programmed cell death ligand (s PD-L1) in predicting the prognosis of invasive non-Hodgkin's lymphoma (NHL). Methods The clinical data of 112 patients with invasive NHL [diffused large B cell lymphoma (DLBCL) ] who were admitted to the hospital during the period from January 2013 to January 2017 were collected. 40 normal healthy people who received physical examination in the hospital during the same period were selected as the control group. Fasting peripheral blood samples were collected from all subjects to determine the level of s PD-L1 by double antibody sandwich-enzyme-linked immunosorbent assay (ABC-ELISA). Its relationship with clinicopathological parameters and prognosis of DLBCL was analyzed. Results The level of s PD-L1 in peripheral blood was higher in the case group than in the control group (P ＜0. 05). The level of s PD-L1 in peripheral blood was higher in patients with NHL international prognosis index (IPI) of high risk, at Ann Arbor stage Ⅲ ～ Ⅳ, with tumors ≥10 cm, pathological type of T cell type and with treatment response of SD + PD than in patients with IPI of low risk, at Ann Arbor stage Ⅰ ～ Ⅱ, with tumors ＜ 10 cm, pathological type of B-cell type and with treatment response of CR + PR (P ＜ 0. 05). The survival rate (OS) of patients with high s PD-L1 was significantly lower than that of patients with low s PD-L1 (P ＜ 0. 05). Cox analysis showed that high s PD-L1, Ann Arbor stage Ⅲ ～ Ⅳ and pathological types of T cell type were independent risk factors for poor prognosis of patients with DLBCL (P ＜ 0. 05). Conclusion The expression of s PD-L1 in peripheral blood of patients with DLBCL is significantly higher, and changes in the expression level of s PD-L1 are closely related to the patient's IPI, clinical stage, tumor size, pathological type and response to treatment. They also are risk factors for the prognosis of patients.