感染HBV的弥漫大B细胞淋巴瘤患者临床特征与预后分析  

Clinical characteristics and prognostic analysis of diffuse large B-cell lymphoma patients with HBV infection

作　　者：黄燕华[1] 杨晟[1] 石远凯[1] 杨建良[1] 张长弓[1] 秦燕[1] 刘鹏[1] 董梅[1] 周生余[1] 何小慧[1] 

机构地区：[1]中国医学科学院、北京协和医学院、肿瘤医院肿瘤内科,北京100021

出　　处：《癌症进展》2012年第3期289-295,共7页Oncology Progress

基　　金：高等学校博士学科点专项科研基金资助课题(项目编号:200800230019);人事部回国人员科技活动项目择优资助课题

摘　　要：目的探讨HBV感染与弥漫大B细胞淋巴瘤(DLBCL)的关系。方法回顾性分析308例有乙肝两对半检测记录的初治DLBCL患者,分为HBV携带者(HBsAg+)31例、HBV既往感染者(HBsAg-/HbcAb+)90例、无HBV感染者(HBsAg-/HbcAb-)118例,接受CHOP样或R-CHOP样方案化疗。对三组患者的临床特征、生存及化疗期间与化疗结束12个月内肝功能损害情况进行比较分析。结果三组患者3年总体生存时间(OS)分别为80.9%、74.3%和84.1%,无统计学差异(P=0.946);无进展生存时间(PFS)亦无统计学差异(P=0.405)。采用COX回归多因素分析生存的不良预后因素包括男性、年龄大于60岁、IPI评分高、晚期、未联合利妥昔单抗。三组化疗期间肝功能损害发生率分别为36.8%、27.3%、62.1%,HBsAg+组在化疗期间及结束后1～3个月内肝功损害严重度明显高于其他两组,具有统计学差异,P值分别为0.00039和0.008。结论 HBsAg-/HBcAb-、HBsAg-/HBcAb+、HBsAg+三组临床特征生存时间相似,采用联合利妥昔单抗的方案化疗能提高全组患者生存。本研究推荐对HBsAg+的DLBCL患者化疗或免疫治疗时进行预防性抗病毒治疗,同时建议抗病毒治疗至少须延续至化疗结束后3个月,化疗中与化疗后均须密切监测肝功能、HBV-DNA水平。Objective To explore the relationship between Hepatitis B virus （HBV） and diffuse large B-cell lympho- ma （DLBCL）. Methods In this retrospective study, 308 cases of DLBCL patients were divided into three groups as HB- sAg ＋ （31 patients）, HBsAg-/HbcAb ＋ （90 patients） and HBsAg-/HbcAb- （118 patients）. All of them received CHOP-like or RCHOP-like chemotherapy. Various statistical analyses were used to analyze the clinical parameters and he- patic dysfunction of those three groups during and after the chemotherapy. Results 3-year overall survival （OS） rate of the three groups were 80. 9%, 74. 3% and 84. 1% respectively, which showed no significant difference, and the same was progression-free survival （PFS） rate. Multivariate analysis by Cox regression showed that sex, age, IPI and rituximap are related to the prognosis. The liver dysfunction incidences of those three groups were 36. 8% , 27.3% and 62. 1% respec- tively during the chemotherapy. Statistical Analysis showed that liver dysfunction of HBsAg ＋ patients was much higher than those two groups both during the chemotherapy and within 3 months after the chemotherapy （P = 0. 00039 and P = 0. 008 respectively）. Conclusion There were no significant differences in clinical parameters and prognosis among the three groups. The use of rituximab increases the overall OS. Prophylactic treatment of HBV was suggested in the cases of HBsAg ＋ patients and continued until 3 months after the treatment, during which the liver function and the level of HBV DNA should be monitored closely.

关 键 词：DLBCL HBSAG 临床特征 肝功能损害 预后 

分 类 号：R733.1[医药卫生—肿瘤]