隐匿性HBV感染在多发性骨髓瘤发病中的作用研究  

Role of occult hepatitis B virus infection in the pathogenesis of multiple myeloma

作　　者：王琦侠[1] 倪庆仁[1] 戴进前[1] 郭亮[1] 谢佳[1] 任婧婧[1] 

机构地区：[1]西安市中心医院血液病研究所,西安市710003

出　　处：《中国肿瘤临床》2015年第14期700-704,共5页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金青年项目(编号:81402751);陕西省自然科学基金项目(编号:2014JM4088)资助~~

摘　　要：目的：探讨乙型肝炎病毒（HBV）感染与多发性骨髓瘤（MM）发病之间的关系，为MM的防治提供流行病学依据。方法：收集2010年10月至2014年10月西安市中心医院、陕西省人民医院、西安市交通大学西北医院等5所三级甲等医院185例新发MM患者的l临床和实验室资料，随机选择在年龄和性别上匹配的同期住院非肿瘤患者作为对照。采用ELISA法检测外周血HBsAg；对于HBsAg阴性者，采用巢式PCR扩增检测HBVDNA的S、C区基因。用SPSS16．0统计学软件进行组间的差异比较；HBV与MM发病之间的关系采用Logistic回归分析。结果：MM患者的HBsAg阳性率为8．11％（15／185），隐匿性HBV感染（occulthepatitisBvirusinfection，OBI）阳性率为3．53％（6／170），HBV的总感染率为1l-35％（21／185）；对照组的HBsAg阳性率为4．40％（8／182），OBI阳性率为0．57％（1／174），HBV的总感染率为4．95％（9／182）。两组HBsAg和OBI阳性率的差异均无统计学意义（P〉0．05），但MM患者HBV总感染率显著高于对照组（x。=-5．02，P〈0．05）；其OR值为2．46（95％C1：1．10～5．53），P〈0．05。另外，HBV感染者Ⅲ期MM所占比例明显高于未感染者（85．71％VS．60．37％，X2=5．15，P〈0．05）；血白蛋白水平在HBV感染者中较未感染者明显减低（x2=5．60，P〈0．05），K／λ轻链比值在HBV感染者中明显低于未感染者（P〈0．05）。结论：将OBI纳入分析后，感染HBV发生MM的风险较未感染者明显增高；伴有HBV感染的MM患者肝脏损害更为严重，建议对HBsAg阴性的MM患者在化疗前开展OBI筛查，以预防出现HBV再激活而影响生存期。Objective： To explore the relationship between hepatitis B virus （HBV） infection and the pathogenesis of multiple my- eloma （MM）, in order to provide an epidemiological evidence for the prevention and treatment of MM. Methods： Clinical and epidemi- ological data of 185 MM patients and 182 non-tumorous patients were collected. Subjects were randomly selected from in-patients who were homeochronously admitted to the same five grade-III A hospitals, including Xi＇an Central Hospital, Shaanxi People＇s Hospital, Xi＇an Jiaotong University Xibei Hospital, and so on. MM patients were selected in terms of age and gender. Peripheral blood HBsAg was fissayed by ELISA. If HBsAg was negative, the S and C-gene fragments of HBV DNA were tested using nested PCR. Fisher＇s ex- act test or X2 test （SPSS statistical software） was used to compare the differences between the groups. Logistic regression was employed to examine the association between the pathogenesis of MM and HBV infection. Results： In MM patients, the HBsAg positive rate was 8.11% （15/185）, the occult HBV infection （OBI） positive rate was 3.53% （6/170）, and the total HBV infection rate was 11.35% （21/ 185）. For the control group, the HBsAg positive rate was 4.40% （8/182）, the OBI positive rate was 0.57% （1/174）, and the total HBV in- fection rate was 4.95% （9/182）. No statistical difference in HBsAg or OBI positive rate was found between the two groups （P〉0.05）. However, MM patients showed significantly higher total HBV infection rate than that of the controls [X2=5.02, P〈0.05; OR was 2.46 （95% CI： 1.10-5.53, P〈0.05）]. Additionally, the proportion of ISS stage III was significantly higher in MM patients with HBV infection than in uninfected MM patients （85.71% vs. 60.37%, X2=5.15, P〈0.05）. Patients with HBV infection showed reduced albumin level （X2 5.60, P〈0.05） and a K/λ light chain ratio （P〈0.05） compared with uninfected patients. Conclusion： The risk of MM pathogenesis after

关 键 词：多发性骨髓瘤 乙型肝炎病毒 隐匿性感染 病例对照研究 

分 类 号：R733.3[医药卫生—肿瘤]