目的 探讨高危型腺性膀胱炎(cystitis glandularis,CG)经尿道等离子电切术及灌注化疗后患者血清生存素(survivin)、干扰素γ(interferon gamma,IFN-γ)/白细胞介素4(interleukin 4,IL-4)、中性粒细胞与淋巴细胞比值(neu-trophil-to-lymphocyte ratio,NLR)变化及其与复发的关系.方法 选取2018-06/2021-06月作者医院收治的364例高危型CG患者为研究对象.所有高危型CG患者均行经尿道等离子电切术及灌注化疗治疗.术后随访两年,根据膀胱镜检查及活体组织检查复查出现CG为依据将患者分为复发组(n=32)和未复发组(n=323).分析治疗后高危型CG患者的临床疗效,并比较治疗前后高危型CG患者血清survivin、IFN-γ/IL-4、NLR的变化.比较复发与未复发高危型CG患者临床资料,分析影响高危型CG患者复发的危险因素及血清survivin、IFN-γ/IL-4、NLR对高危型CG患者复发的预测价值.结果 高危型CG患者经尿道等离子电切术及灌注化疗的临床疗效总有效率为94.78％.治疗后高危型CG患者血清survivin、NLR水平较治疗前降低,IFN-γ/IL-4较治疗前升高(P均＜0.05).随访两年后,失访患者9例,剩余355例,其中复发32例(9.01％).复发组高危型CG患者病灶位置弥漫型比例及血清survivin、NLR水平高于未复发组,血清IFN-γ/IL-4低于未复发组(P均＜0.05).Logistic回归分析结果显示,血清survivin、NLR是高危型CG患者经尿道等离子电切术及灌注化疗后复发的独立危险因素,IFN-γ/IL-4是保护因素.血清survivin、IFN-γ/IL-4、NLR及三者联合预测高危型CG患者经尿道等离子电切术及灌注化疗后复发的曲线下面积(area under the cure,AUC)分别为0.868、0.664、0.712、0.911,三者联合预测的AUC高于survivin、IFN-γ/IL-4、NLR单独预测的AUC.高危型CG患者经尿道等离子电切术及灌注化疗后血清survivin＞53.2 pg/ml、NLR＞1.99术后复发率高于survivin≤53.2 pg/ml、NLR≤1.99的患者,IFN-γ/IL-4＞3.43 术后复发率低于 IFN-γ/IL-4≤4.43 的患者(Log-rank x2值分别为 110.369、22.805、52.093,P均＜0.01).结论 经尿道等离子电切术及灌注化疗治疗高危型CG疗效显著,可降低患者血清survivin、NLR水平,提高IFN-γ/IL-4,可降低术后复发率.
Changes in Serum Survivin,IFN-γ/IL-4 and NLR After Transurethral Plasma Electrosurgery and Perfusion Chemotherapy for High-risk Cystitis Glandularis and Its Relationship with Recurrence
Objective To investigate the changes of serum survivin,interferon gamma(IFN-γ)/interleukin-4(IL-4),neutrophil-to-lymphocyte ratio(NLR)and its relationship with recurrence in high-risk cystitis glandularis(CG)after transurethral plasma electrocision and perfusion chemotherapy.Methods A total of 364 patients with high-risk CG ad-mitted to author's hospital from June 2018 to June 2021 were selected as study subjects.All the high-risk CG patients were treated with transurethral plasma electrosurgery and perfusion chemotherapy.The patients were followed up for two years,and they were divided into recurrence group(n=32)and non-recurrence group(n=323)according to the presence of CG in microscopy and biopsy.The clinical efficacy of high-risk CG patients after treatment was analyzed and the chan-ges of serum survivin,IFN-γ/IL-4 and NLR before and after treatment were compared;the clinical data of high-risk CG patients with and without recurrence were compared,the risk factors for recurrence in high-risk CG patients and the pre-dictive value of serum survivin,IFN-γ/IL-4 and NLR for high-risk CG recurrence were analyzed.Results The overall ef-fective rate of transurethral plasma electrosurgery and perfusion chemotherapy was 94.78％.Serum survivin and NLR levels of high-risk CG patients decreased and IFN-γ/IL-4 increased after treatment(all P＜0.05).After two years of follow-up of all the patients,9 patients were lost to fol-low-up and 355 patients remained,of whom 32(9.01％)had recurrence.The proportion of diffuse type of lesion location and serum survivin and NLR levels of high-risk CG patients were higher in the recurrence group than in the non-recurrence group,serum IFN-γ/IL-4 was lower than that in the non-recurrence group(all P＜0.05).Logistic regression analysis showed that serum survivin and NLR were independent risk factors for recurrence after transurethral plasma elec-trocautery and perfusion chemotherapy in high-risk CG patients,and IFN-γ/IL-4 was a protective factor.The area under the curve(AUC)of serum survivin,IFN-γ/IL-4,NLR and the combination of the three for predicting recurrence after transurethral plasma electrosurgery and perfusion chemotherapy for high-risk CG patients were 0.868,0.664,0.712,0.911,and the AUC of combined prediction of the three was higher than that of survivin,IFN-γ/IL-4 and NLR alone.After transurethral plasma electrosurgery and perfusion chemotherapy,the postoperative recurrence rate of high-risk CG patients with serum survivin＞53.2 pg/ml and NLR＞1.99 was higher than that of patients with survivin≤53.2 pg/ml and NLR≤1.99,the postoperative recurrence rate of patients with IFN-γ/IL-4＞3.43 was lower than that of IFN-γ/IL-4≤4.43(Log-rank x2 were 110.369,22.805,52.093 respectively,all P＜0.01).Conclusion Transurethral plasma e-lectrosurgery and perfusion chemotherapy are effective in the treatment of high-risk CG,which can reduce serum survivin and NLR levels,increase IFN-γ/IL-4 and reduce postoperative recurrence rate.
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