【摘要】 目的 探讨宫颈鳞状细胞癌患者血清免疫球蛋白G4(IgG4)水平与放疗敏感性的关系及临床意义。方法 收集30例接受三维适形调强放射治疗的局部中晚期宫颈鳞状细胞癌患者的病历资料。分别于放疗前1周、放疗中（首次后装内照射时）及放疗结束后4周采集患者的空腹静脉血，应用酶联免疫吸附试验检测血清IgG4水平。根据临床疗效的不同，完全缓解（CR）患者为放射高敏感组，部分缓解（PR）+疾病稳定（SD）+疾病进展（PD）患者为放射低敏感组。比较放疗前后患者的血清IgG4水平，比较放射高敏感组和放射低敏感组患者的血清IgG4水平及临床特征。绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），分析放疗前1周血清IgG4水平对宫颈鳞状细胞癌放疗疗效的预测价值。结果 30例宫颈鳞状细胞癌患者中，CR 14例，PR 13例，SD3例，PD 0例。放疗中和放疗结束后4周，宫颈鳞状细胞癌患者的血清IgG4水平均低于放疗前1周，差异均有统计学意义（P﹤0.05）。放射低敏感组患者放疗前1周的血清IgG4水平明显高于放射高敏感组患者，差异有统计学意义（P﹤0.01）。放射高敏感组和放射低敏感组宫颈鳞状细胞癌患者的肿瘤直径和分化程度比较，差异均有统计学意义（P﹤0.05）。ROC曲线分析结果显示，放疗前1周血清IgG4水平预测宫颈鳞状细胞癌患者放疗疗效的AUC为0.836(95%CI:0.685～0.986)，截断值为692.265μg/ml，灵敏度为73.3%，特异度为93.3%。结论 宫颈鳞状细胞癌患者放疗前血清IgG4水平可能与放疗敏感性相关，放射低敏感患者血清IgG4水平较高，疗效较差，提示血清IgG4可能成为评估宫颈鳞状细胞癌患者放疗敏感性的生物标志物。更多还原

【Abstract】 Objective To investigate the relationship between serum immunoglobulin G4(IgG4) level and radiosensitivity in patients with cervical squamous cell carcinoma and its clinical significance. Method The medical records of 30patients with locally advanced cervical squamous cell carcinoma who received three-dimensional conformal intensitymodulated radiation therapy were collected. Fasting venous blood was collected from patients 1 week before the radiotherapy, during the radiotherapy(the first post-installation internal irradiation), and 4 weeks after the radiotherapy, and serum IgG4 levels were detected by enzyme-linked immunosorbent assay. Patients were divided into varying groups according to their clinical efficacy. Among them, patients with complete response(CR) were divided into the high-radiosensitivity group, and patients with partial response(PR) + stable disease(SD) + progressive disease(PD) were divided into the lowradiosensitivity group. The serum IgG4 levels of patients before and after the radiotherapy were compared, and the serum IgG4 levels and clinical significance of patients in high-radiosensitivity group and low-radiosensitivity group were compared. The receiver operating characteristic(ROC) curve was drawn, the area under the curve(AUC) was calculated, and the predictive value of serum IgG4 level one week before the radiotherapy on the efficacy of radiotherapy for cervical squamous cell carcinoma was also analyzed. Result Among 30 cervical squamous cell carcinoma patients, 14 were CR,13 were PR, 3 were SD, and 0 was PD. During the radiotherapy and 4 weeks after the radiotherapy, the serum IgG4 levels of patients with cervical squamous cell carcinoma were lower than that 1 week before the radiotherapy, and the differences were statistically significant(P<0.05). The serum IgG4 level of the patients in the low-radiosensitivity group one week before the radiotherapy was significantly higher than that of the patients in the high-radiosensitivity group, and the difference was statistically significant(P<0.01). There were statistically significant differences in the tumor diameter and differentiation degree of patients between the high-radiosensitivity group and the low-radiosensitivity group(P<0.05). The results of the ROC curve analysis showed that the AUC of serum IgG4 level one week before the radiotherapy in predicting the efficacy of cervical squamous cell carcinoma was 0.836(95%CI: 0.685-0.986), the cut-off value was 692.265 μg/ml,the sensitivity was 73.3%, and the specificity was 93.3%. Conclusion Serum IgG4 level before radiotherapy in patients with cervical squamous cell carcinoma may be related to radiosensitivity. Patients with low radiosensitivity had higher serum IgG4 levels and poorer efficacy, which is suggested that serum IgG4 may be a biomarker for evaluating the radiosensitivity of patients with cervical squamous cell carcinoma.更多还原