681例弥漫大B细胞淋巴瘤患者的临床特征分析  

The clinical characteristics of 681 patients with diffuse large B-cell lymphoma

作　　者：文菁菁[1] 刘志彬[1] 徐娟[1] 徐才刚[1] 

机构地区：[1]四川大学华西医院血液科、血液病研究室,成都610041

出　　处：《中华血液学杂志》2012年第12期1004-1009,共6页Chinese Journal of Hematology

摘　　要：目的分析弥漫大B细胞淋巴瘤（DLBCL）患者的临床特征，以提高对疾病的认识。方法对2000年1月至2010年12月681例DLBCL患者临床特征、实验室指标及免疫分型等资料进行回顾性分析。结果681例患者中，男女比例1．42：1，中位年龄56岁，Ⅲ一Ⅳ期者占51．4％，有B症状者占37．6％，IPI评分中高危（3～5分）者占30．2％，结外起病者占49．8％，胃肠道受累占结外器官受累者的29．0％。淋巴细胞绝对计数（ALC）降低38．3％，LDH升高56．1％，β2微球蛋白（B2-MG）升高83．0％。有B症状组患者骨髓受累比例是无B症状组的5．2倍（OR=5．212，95％CI：2．821～9．632，P=0．000）。268例可进行免疫分型的患者中，生发中心B细胞（GCB）型76例（28．4％）、non—GCB型192例（71．6％）；non-GCB型患者组有乙型肝炎（乙肝）病史者、LDH升高者、Bcl-2阳性表达率均多于GCB型患者组（P〈0．05），两型在各年龄组、不同Ki-67、不同IPI评分间差异无统计学意义（P〉0．05）。Ki-67I〉60％时，结外起病者比例明显增多（51．8％对38．7％，P=0．008）；IPI3—5分组患者中ALC降低者多于IPl0～2分组（P=0．000）。多因素分析发现IPI3～5分是影响患者生存的独立因素（P=0．000）。结论DLBCL患者中年男性起病多见，结内、结外比例相当，易有胃肠道受累；non—GCB型患者多于GCB型（前者有乙肝病史者居多、Bcl-2阳性表达率更高），ALC降低多见于IPI评分中高危组，IPI评分是影响OS的独立预后因素。Objective To analyze clinical features and the differences of GCB and non-GCB pheno- types for diffuse large B-cell lymphoma （DLBCL） in different age groups, Ki-67 index and international prog- nostic index （IPI）. Methods Clinical data of 681 patients with DLBCL hospitalized in West China Hospital from January 2000 to December 2010 were retrospectively analyzed. Results Of these DLBCL cases, the median age was 56 years old with a male predominance, 51.4% stage - , 37.6% B symptoms, 30.2% IPI 3 -5 scores, 49.8% from extranodal sites, 29.0% gastrointestinal tract infiltration, 38.3% low absolute lymphocyte count （ ALC）, 56.1% elevated serum lactate dehydrogenase （LDH） level, 83.0% elevated 32- microglobulin （132-MG） level. B symptoms was associated with bone marrow involvement with the odds ratio 5. 212 （95% CI 2. 821 -9. 632, P =0. 000）. Among 268 with DLBCL patients classified by Hans＇ classifi- cation, 28.4% were GCB and 71.6% non-GCB. The proportions of patients with HBsAg-positive, elevated serum LDH level and Bcl-2 positive expression in non-GCB group was higher than those in GCB group （P 〈 0.05 ）. The differences between GCB and non-GCB DLBCL were not revealed in terms of age subgroups, Ki- 67 expression status and IPI subgroups. The high （ I〉60% ） Ki-67 group included more patients with extran- odal site involvement compared with the low （ 〈60% ） Ki-67 group （51.8% vs 38.7%, P =0.008）. The proportion of patents with low ALC in IPI 3 - 5 scores group was higher than in IPI 0 - 2 scores group （ P = 0. 000）. The multivariate analysis showed that high IPI had statistically significant negative influence on sur- vival （ P = 0. 000）. Conclusions Most patients with DLBCL were middle-aged male from our data. The pa- tients with primary nodal （PN） was almost equal to those with primary extranodal （PEN）. The most frequent extranodal site was gastrointestinal tract. The non-GCB phenotype was significantly more common than GCB phenotype in this study, and

关 键 词：淋巴瘤 大细胞 弥漫性 临床研究 免疫表型分型 生发中心 预后 

分 类 号：R733.1[医药卫生—肿瘤]