CAJ | 학술논문

目的探讨嗜血细胞性淋巴组织细胞增多症(HLH)患儿化疗过程中细胞因子表达水平变化趋势,分析其临床意义.方法 2011年1月至2013年5月确诊的16例HLH患儿按预后分为HLH缓解组和死亡组,收集两组患儿入院时及化疗第7、14、21、28、42天的血清标本,分别分为HLH 1～6组、HLH a～d组,应用酶联免疫吸附法(ELISA)检测标本中白细胞介素(IL)-18、IL-10、IL-12、肿瘤坏死因子α(TNF-α)、细胞核因子κB(NF-κB)及新蝶呤水平变化,分析两组细胞因子变化趋势.结果缓解组患儿血清各细胞因子水平随着化疗的进行而下降,除新蝶呤及NF-κB水平HLH1组与HLH2组比较、TNF-α水平HLH1组与HLH5组及HLH6组比较差异均无统计学意义外(均P＞0.05),HLH1组与其余组相比差异均有统计学意义(均P＜ 0.05).死亡组患儿NF-κB、IL-12及新蝶呤水平未见下降,HLHa与其他HLH组相比差异均无统计学意义(均P＞0.05);TNF-α有下降趋势,HLHa组与HLHc、HLHd组相比差异均有统计学意义(P值分别为0.049、0.000);IL-10在化疗第1周可见明显下降,HLHa组与HLHb组相比差异有统计学意义(P=0.00);IL-18在化疗第1～2周有下降趋势,HLHa组与HLHb组、HLHa组与HLHc组相比差异均有统计学意义(P值分别为0.03、0.02).结论 HLH缓解患儿血清IL-18、IL-10、IL-12、NF-κB及新蝶呤的表达水平均随着化疗的进行而下降,死亡组患儿上述指标下降趋势不明显,初步证实HLH患儿化疗过程中细胞因子变化趋势与预后有关.
목적 탐토기혈세포성림파조직세포증다증(HLH)환인화료과정중세포인자표체수평변화추세,분석기림상의의.방법 2011년1월지2013년5월학진적16례HLH환인안예후분위HLH완해조화사망조,수집량조환인입원시급화료제7、14、21、28、42천적혈청표본,분별분위HLH 1～6조、HLH a～d조,응용매련면역흡부법(ELISA)검측표본중백세포개소(IL)-18、IL-10、IL-12、종류배사인자α(TNF-α)、세포핵인자κB(NF-κB)급신접령수평변화,분석량조세포인자변화추세.결과 완해조환인혈청각세포인자수평수착화료적진행이하강,제신접령급NF-κB수평HLH1조여HLH2조비교、TNF-α수평HLH1조여HLH5조급HLH6조비교차이균무통계학의의외(균P＞0.05),HLH1조여기여조상비차이균유통계학의의(균P＜ 0.05).사망조환인NF-κB、IL-12급신접령수평미견하강,HLHa여기타HLH조상비차이균무통계학의의(균P＞0.05);TNF-α유하강추세,HLHa조여HLHc、HLHd조상비차이균유통계학의의(P치분별위0.049、0.000);IL-10재화료제1주가견명현하강,HLHa조여HLHb조상비차이유통계학의의(P=0.00);IL-18재화료제1～2주유하강추세,HLHa조여HLHb조、HLHa조여HLHc조상비차이균유통계학의의(P치분별위0.03、0.02).결론 HLH완해환인혈청IL-18、IL-10、IL-12、NF-κB급신접령적표체수평균수착화료적진행이하강,사망조환인상술지표하강추세불명현,초보증실HLH환인화료과정중세포인자변화추세여예후유관.
Objective To investigate the trend of cytokines in patients with hemophagocytic lymphohistiocytosis (HLH) and analyze its significance.Methods 16 patients with HLH from January 2011 to May 2013 were selected.The patients were divided into remission group and death group by prognosis.Serums of the two groups were collected when they were hospitalized and at 7 th,14 th,21st,28th and 42nd day during chemotherapy,and they were fractionated HLH 1-6 groups and HLH a-d groups again,then the levels of IL-18,IL-10,IL-12,NF-κB,TNF-α and neopterin were tested by enzyme linked immuno sorbent assay (ELISA) to analysis their trend.Results The levels of all of cytokines in the remission group declined with chemotherapy,the difference between HLH1 group and another HLH groups was statistically significant (P ＜ 0.05).In the death group,the levels of NF-κB,IL-12 and neopterin had no downward trend with chemotherapy,and the difference between HLHa group and another HLH groups was not statistically significant (all P ＞ 0.05).The level of TNF-α declined with chemotherapy,and the differences between HLHa group and HLHc group,HLHa group and HLHd group were statistically significant (P =0.049,0.000).The level of IL-10 declined sharply in the first week of chemotherapy,and the difference between HLHa group and HLHb group was statistically significant (P =0.00).The level of IL-18 declined after the 2nd-weeks' chemotherapy,and the differences between HLHa group and HLHb group,HLHa group and HLHc group were statistically significant (P =0.03,0.02).Conclusions In the remission patients,the levels of serum IL-18,IL-10,IL-12,NF-κB,TNF-α and neopterin declined after chemotherapy.In the death patients,the downward trend is not obvious.It was preliminarily confirmed that the prognosis of HLH is related to the trend of cytokines during chemotherapy.