陈月苗　翁珊珊　郑翠苹　蔡小平　吴圣豪　石岳坚　黄健

[关键词] 淋巴瘤;滤泡性;细胞因子谱;白细胞介素类

[中图分類号] R733.1          [文献标识码] A          [文章编号] 1673-9701（2021）23-0025-05

Clinical significance of Th1/Th2 cytokine profiles in follicular lymphoma

CHEN Yuemiao   WENG Shanshan   ZHENG Cuiping   CAI Xiaoping   WU Shenghao   SHI Yuejian   HUANG Jian

Department of Blood Chemotherapy， Wenzhou Central Hospital in Zhejiang Province， Wenzhou   325000， China

[Abstract] Objective To study the levels of Th1/Th2 cytokine profiles in peripheral blood of patients with follicular lymphoma at initial diagnosis， and to understand their significance in the development of disease. Methods A total of 30 patients with follicular lymphoma diagnosed in our hospital from January 2015 to June 2019 were selected. The levels of peripheral blood Th1/Th2 cytokine profiles in selected patients at initial diagnosis and after treatment were determined by CBA technology， and compared with those in 30 healthy persons in our hospital. The clinical significance of cytokine profiles was discussed. Results ①The levels of IL-2， IL-6， IL-10 and TNF in 30 patients with follicular lymphoma at initial diagnosis were higher than those in healthy persons.②In patients with follicular lymphoma， the levels of IL-2， IL-10 and IFN-γ in the lactate dehydrogenase （LDH） increased group were higher than those in the normal LDH group（Wilcoxon W values  were 102.500， 89.000， 95.500， and P values were 0.021， 0.004， 0.009）. The levels of IL-2， IL-4， IL-10 and IFN-γ in the β2 microglobulin （β2-MG） increased group were higher than those in the normal β2-MG group（Wilcoxon W values  were 76.500， 77.500， 69.500， 63.500， and P values  were 0.026， 0.029， 0.011， and 0.005）. The level of IL-2 in the high-risk group [Follicular Lymphoma International Prognostic Index （FLIPI） score 3 to 5] was significantly higher than that in the low-and middle-risk group （score 0 to 2） （Wilcoxon W value was 125.000， P value was 0.010）.③After treatment， the levels of IL-2， IL-6， IL-10 and TNF in the 30 patients with follicular lymphoma were significantly lower than those at initial diagnosis. Conclusion The levels of IL-2， IL-6， IL-10 and TNF in peripheral blood of patients with follicular lymphoma at initial diagnosis are higher than those in normal physical exam. The expression levels of cytokines and clinical characteristics of patients with follicular lymphoma are correlated.

[Key words] Lymphoma; Follicular; Cytokine profile; Interleukins

濾泡性淋巴瘤（Follicular lymphoma，FL）由不同比例的中心细胞和中心母细胞构成其肿瘤性滤泡[1]，约占我国非霍奇金淋巴瘤（Non-hodgkin lymphoma，NHL）的8.1%～23.5%[2]，在西方国家占20%左右，居东南亚NHL第二位[3]。FL的临床表现不一，以无痛性外周淋巴结肿大为主要症状，易引起骨髓侵犯。利妥昔单抗、氟达拉滨及苯达莫司汀[4-5]等药物的使用使FL的治疗效果明显改善。但FL在临床、遗传和分子水平上表现出明显的异质性[6]，且不可治愈，大部分患者经标准治疗后最终仍复发，甚至部分患者短期内迅速进展。细胞因子是由肿瘤细胞及周围的免疫细胞经刺激而产生分泌的小分子蛋白质，主要参与免疫应答调节、抗肿瘤、刺激造血功能及介导炎症反应等。本文检测初诊FL患者的外周血细胞因子水平，并研究其与FL疾病发展的关系，现报道如下。

1 资料与方法

1.1 一般资料

选取2015年1月至2019年6月期间经病理学证实的在我院血液科初诊的FL患者，排除标准：①免疫缺陷或免疫抑制的患者;②合并感染的患者。另外随机选取30例我院体检中心健康志愿者为对照组。FL组30例，其中男16例，女14例，年龄39～82岁，平均（65.27±12.33）岁;健康对照组30例，其中男20例，女10例，年龄34～82岁，平均（64.10±11.27）岁。两组患者的性别、年龄比较，差异无统计学意义（P>0.05），具有可比性。

1.2 方法

采用标准治疗R-CHOP方案化疗，具体为：利妥昔单抗375 mg/m2 d1静脉滴注+环磷酰胺750 mg/m2 d2静脉滴注+长春新碱1.4 mg/m2 d2静脉滴注（最大量2 mg）+多柔比星50 mg/m2 d2静脉滴注+泼尼松100 mg d2～6口服。