【摘要】 目的探讨非小细胞肺癌(NSCLC)脑转移患者血清S100B、外泌体miR-330表达变化以及与调强放疗近期疗效和远期疗效的关系。方法选择2017年1月至2019年12月在河北医科大学第四医院接受治疗的局部晚期NSCLC术后脑转移患者60例,所有患者完成计划放疗。分别于放疗前后采集血液样本,检测血清S100B和外泌体miR-330表达。结果放疗结束后,临床有效率为80.0%(48/60),作为临床有效组;另12例患者为临床无效组。随访期间共46例患者死亡。接受放疗前后,临床有效组患者血清S100B水平均低于无效组[(50.60±8.45)μg/ml vs.(60.21±7.00)μg/ml,(64.94±8.10)μg/ml vs.(75.87±11.32)μg/ml],同时血清外泌体miR-330水平高于无效组[(0.52±0.18) vs.(0.39±0.17),(0.54±0.19) vs.(0.40±0.19)],差异具有统计学意义(P<0.05);此外存活组患者血清S100B水平均低于死亡组[(45.48±7.01)μg/ml vs.(54.67±8.48)μg/ml,(59.11±4.88)μg/ml vs.(69.57±9.61)μg/ml],同时血清外泌体miR-330水平高于死亡组[(0.62±0.14) vs.(0.45±0.17),(0.67±0.15) vs.(0.46±0.18)],差异具有统计学意义(P<0.05)。多因素Cox风险比例回归模型结果显示,治疗前血清S100B和外泌体miR-330、治疗后血清外泌体miR-330是影响患者预后的独立因素(P<0.05);且预测患者死亡的ROC曲线下面积分别为0.804(95%CI:0.763～0.895)、0.771(95%CI:0.728～0.845)、0.811(95%CI:0.745～0.898)。结论对于局部晚期NSCLC术后脑转移患者,血清S100B水平升高和外泌体miR-330水平降低与放疗近期疗效和远期生存预后密切相关。更多还原

【Abstract】 Objective To investigate the changes of serum S100 B and exosome miR-330 expression in patients with nonsmall cell lung cancer( NSCLC) with brain metastasis and their correlation with the short-term and long-term efficacy of IMRT.Methods A total of 60 local advanced NSCLC patients with brain metastasis after surgery in our hospital were enrolled into this study from Jan. 2017 to Dec. 2019. All patients were treated with radiotherapy. The blood samples before and after radiotherapy were collected and used to detect the serum S100 B and exosome miR-330 levels. Results After radiotherapy treatment,the clinical efficacy rate was 80. 0%( 48/60) as effective group,while other 12 patients were in the ineffective group. During the follow-up,46 patients died. Before or after radiotherapy,serum S100 B levels in effective group were lower than ineffective group [( 50. 60±8. 45) μg/ml vs.( 60. 21±7. 00) μg/ml,( 64. 94±8. 10) μg/ml vs.( 75. 87±11. 32) μg/ml],while serum exosome miR-330 in effective group were higher than ineffective group [( 0. 52±0. 18) vs.( 0. 39±0. 17),( 0. 54±0. 19) vs.( 0. 40± 0. 19) ]( P< 0. 05). Serum S100 B levels in survival group were lower than death group [( 45. 48±7. 01) μg/ml vs.( 54. 67±8. 48) μg/ml,( 59. 11±4. 88) μg/ml vs.( 69. 57±9. 61) μg/ml],while exosome miR-330 in survival group were lower than death group [( 0. 62± 0. 14) vs.( 0. 45± 0. 17),( 0. 67±0. 15) vs.( 0. 46±0. 18) ]( P<0. 05). Multivariate Cox regression results showed that serum S100 B and exosome miR-330 before SRT and serum exosome miR-330 after radiotherapy would be the independent factors of prognosis( P<0. 05),whose area under ROC curve were respectively 0. 804( 95%CI: 0. 763-0. 895),0. 771( 95%CI: 0. 728-0. 845),0. 811( 95%CI: 0. 745-0. 898). Conclusion In local advanced NSCLC patients with brain metastasis,the increase of serum S100 B level and the decrease of exosome miR-330 level are closely related to the short-term effect of radiotherapy and long-term survival prognosis.更多还原