淋巴细胞绝对数减少在非霍奇金淋巴瘤中的临床意义  

The clinical significance of absolute lymphocyte count in non-Hodgkin lymphoma

作　　者：舒文秀[1] 乐静[1] 万斌[1] 谌登兵[1] 宋燕萍[1] 

机构地区：[1]宁波市医疗中心李惠利医院血液科,浙江宁波315040

出　　处：《临床血液学杂志》2011年第3期273-275,共3页Journal of Clinical Hematology

摘　　要：目的:探讨非霍奇金淋巴瘤(NHL)患者初发时淋巴细胞绝对数(ALC)与其临床特征的相关性,并探讨其预后参考价值。方法:回顾性分析2007年1月-2010年10月间我院新确诊的210例NHL患者的临床特征,结合随访资料,分析不同ALC水平与NHL患者各临床特征及其预后的相关性。结果:在本组NHL病例中,中位年龄58岁,结外淋巴瘤占有一定比例(47.1%)。ALC中位数为1.2(0.1～13.9)×109/L,25%～75%的置信区间分界值为(0.7～1.8)×109/L。我们发现,ALC<1.2×109/L时,其与患者的年龄、性别、淋巴瘤类型、临床分期、IPI预后指数、骨髓浸润、贫血等临床特征并无显著相关性,但常伴有LDH水平的升高,且表现B症状,而此类患者临床缓解率相对较低,死亡率较高(P<0.05)。继续以ALC<1.0×109/L作为分界点时,除上述特点外,年龄差异开始具有统计学意义,ALC减少更多见于老年淋巴瘤患者(P<0.01)。最后以ALC<0.7×109/L作为临床分界点时,ALC减少的NHL患者除了涵盖上述临床特点外,T细胞淋巴瘤所占比例也明显升高(P<0.01),此类患者临床分期更晚,IPI积分更高,β2-MG水平更高(P<0.05),治疗缓解率更低,死亡率更高(P<0.05)。结论:ALC减少可以作为NHL患者,特别是老年性NHL患者的辅助性预后判断指标。Objective：To investigate the clinical significance and prognostic value of peripheral blood absolute lymphocyte count（ALC） at admission for patients with non-Hodgkin lymphoma.Method：Clinical features and follow-up data of 210 patients with pathologically confirmed NHL in our hospital between January 2007 and October 2010 were reviewed.Then,the relationship between different ALC levels and the clinical features and prognosis of NHL patients was analyzed.Result：In our data,the median age of patients was 58 years and approximately 47.1% patients belonged to primary extranodal non-Hodgkin＇s lymphoma（PE-NHL）.The median ALC at diagnosis was 1.2×109/L（range：0.10～13.9×109/L）.In this series,different cut-off points between 25% and 75% quartiles were 0.7～1.8×109/L.Patients with an ALC of 1.2×109/L at diagnosis tended to have a high rate of elevated LDH level and B symptoms.These patients were more likely to achieve a lower rate of complete remission（CR） and a higher rate of death（P0.05）.No significant differences were found in age,gender,type of lymphoma,clinical stage,IPI score,bone marrow involvement,anemia and other clinical features.When we used ALC1.0×109/L as the cut-off point,significant difference of age was found between the groups besides the characters mentioned above.Older patients were more likely to have a lower ALC（P0.01）.Then we used ALC0.7×109/L as the cut-off point,patients with an ALC of 0.7×109/L at diagnosis tended to have more adverse prognostic factors,such as a higher rate of T cell lymphoma（P0.01）,later clinical stage,higher IPI score and a higher rate of elevated β2-MG besides the features mentioned above（P0.05）.Of course they achieved a lower incidence of complete remission（CR） and a higher rate of death（P0.05）.Conclusion：Our data suggest that ALC at diagnosis is a novel,powerful predictor of prognosis in NHL,especially in older patients.

关 键 词：淋巴细胞绝对数 非霍奇金淋巴瘤 临床分期 预后 

分 类 号：R733.4[医药卫生—肿瘤]