不同细胞类型非霍奇金淋巴瘤患者合并HBV感染的临床评价  

Clinical evaluation of hepatitis B virus infection in patients with different type of non-Hodgkin's lymphoma

作　　者：陈洁[1] 王健民[1] 杨建民[1] 章卫平[1] 宋献民[1] 陈莉[1] 

机构地区：[1]第二军医大学长海医院血液科,上海200433

出　　处：《临床血液学杂志》2014年第5期760-765,共6页Journal of Clinical Hematology

基　　金：国家自然科学基金(No:81170499);国家科技部973重大科技项目(No:2011CB965100)

摘　　要：目的：对一组大样本量非霍奇金淋巴瘤（NHL）患者的临床资料及其合并乙肝病毒（HBV）感染的状态进行回顾性分析,探讨HBV感染与不同类型NHL的关系及其对临床治疗、预后的影响。方法：收集929例NHL患者的临床、实验室及随访资料,统计分析HBV感染与NHL患者的细胞学类型、临床病理特征、化疗疗效、无进展生存期（PFS）的关系。结果：本组929例NHL患者,B细胞NHL患者HBV感染率（16.67%）明显高于其他细胞类型的NHL（P=0.045）;在B细胞NHL类型中,以弥漫大B细胞淋巴瘤感染率最高,达19.94%;HBV感染率与B细胞NHL分期密切相关（Ⅲ＋Ⅳ期18.87%∶Ⅰ＋Ⅱ期11.18%,P=0.023）,与IPI评分也有关（〉3分28.27%∶≤3分6.11%,P=0.000）;NHL化疗后,HBV大三阳患者谷丙转氨酶（ALT）和谷草转氨酶（AST）明显上升,以B细胞NHL明显;HBV大三阳NHL患者化疗后疗效差,联用利妥昔单抗（R）的化疗方案能明显改善伴发HBV感染的NHL患者的疗效;B细胞NHL患者化疗后,其PFS在HBsAg阳性和HBsAg阴性者间有明显差异（95%CI 77.387-91.473∶90.026-96.312,P=0.007）,其中大三阳与HBV未感染者的PFS差异有统计学意义（95%CI44.043-91.374∶90.026-96.312,P=0.011）;无论是接受RCHOP还是CHOP方案治疗的患者,大三阳者PFS都是最差的（P=0.038、0.022）。结论：HBV在B细胞性NHL发生发展中起重要作用;NHL患者合并HBV感染可能促进肿瘤进展、降低化疗疗效,并进一步影响患者预后。Objective：Clinical data from a large sample of non-Hodgkin＇s lymphoma（NHL）patients with HBV infection were retrospectively analyzed,and the relationship between HBV infection and NHL cell types was clarified and HBV effect on B-cell NHL treatment and prognosis was evaluated.Method：Clinical data from 929 cases of NHL were collected and the relationships between HBV infection and cytological type,clinicopathological characteristics,chemotherapy outcome and PFS in NHL patients were analyzed.Result：In 929 cases of NHL,HBV infection rate was higher in B-cell NHL（16.67%）than that in other cell NHL（P=0.045）;Among the B-cell NHL,the HBV infection rate was highest in diffuse large B cell lymphoma（19.94%）;HBV infection rate was related with B-cell NHL stage（Ⅲ＋Ⅳstage 18.87%vsⅠ＋Ⅱstage 11.18%,P=0.023）,and with IPI score（3scores28.27%vs≤3scores 6.11%,P=0.000）.After chemotherapy,the ALT and AST levels obviously increased in the chronic active HBV infection group,particularly in B-cell NHL patients.Moreover,the chemotherapy outcome for NHL patients with chronic active HBV infection was significantly worse than that for other patients,but the combination with rituximab could improve the outcome of NHL patient with HBV infection.The PFS had a significant difference between B-cell NHL patients with positive HBsAg and negative HBsAg（95%CI77.387-91.473 vs 90.026-96.312,P=0.007）,in which the PFS in the chronic active HBV infection patients was poorer than that in the patients without HBV infection（95%CI44.043-91.374 vs 90.026-96.312,P=0.011）.The PFS of patients with chronic active HBV infection was shortest no matter that the patients received RCHOP or CHOP therapy.Conclusion：The concurrent infection of HBV could be a key factor in the progression of B-cell NHL.The NHL patients with HBV infection may promote tumor progression,decrease chemotherapy outcome and influence patient prognosis.

关 键 词：非霍奇金淋巴瘤 乙肝病毒 化疗 预后 

分 类 号：R733.4[医药卫生—肿瘤]