利妥昔单抗相关间质性肺炎的临床分析  

Clinical analysis of rituximab-induced interstitial pneumonia

作　　者：吕慧娟[1] 董玲[1] 李维[1] 侯芸[1] 宋拯[1] 李兰芳[1] 邱立华[1] 钱正子[1] 周世勇[1] 刘贤明[1] 王华庆[2] 张会来[1] 付凯[1] 

机构地区：[1]天津医科大学肿瘤医院淋巴瘤内科,中美淋巴血液肿瘤诊治中心,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市300060 [2]天津市人民医院肿瘤诊治中心

出　　处：《中国肿瘤临床》2016年第7期291-297,共7页Chinese Journal of Clinical Oncology

摘　　要：目的:分析B细胞非霍奇金淋巴瘤(B cell non-Hodgkin's lymphoma,B-NHL)患者行化疗或免疫化疗后发生间质性肺炎(interstitial pneumonia,IP)与美罗华(利妥昔单抗注射液)的相关性,并分析IP发生的临床特征。方法:回顾性分析天津医科大学肿瘤医院2010年1月至2015年5月期间266例初治CD20^+B-NHL患者的病例资料,将所有病例分为美罗华联合化疗组和单纯化疗组,分析IP的发生与美罗华使用之间的关系,及其相关的临床特点。结果:化疗联合美罗华组中IP的发生率9.6%(13/135)较单纯化疗组2.3%(3/131)高(P<0.05),与IP发生相关的临床特征包括老年、男性、初诊时淋巴细胞计数高于正常值、既往糖尿病史、病理亚型为弥漫性大B细胞性淋巴瘤(diffuse large B-cell lymphoma,DLBCL);淋巴细胞绝对值超过正常范围(HR=14.685,95%CI:3.137~63.234,P=0.001)、糖尿病(HR=8.811,95%CI:1.907~40.720,P=0.005)、病理亚型为DLBCL(HR=0.078,95%CI:0.012~0.489,P=0.006)及美罗华的使用(HR=6.769,95%CI:1.359~33.710,P=0.020)是其发生的独立危险因素。多数患者无明显症状,不需要特殊处理。结论:美罗华可导致IP的发生,可能与免疫力的降低及真菌感染相关,激素冲击疗法联合或不联合抗真菌治疗能取得良好的疗效。Objective： To identify whether the use of rituximab predisposed to interstitial pneumonia（IP） after treatment of B cell nonHodgkin’s lymphoma（B-NHL） with the chemotherapy and immunochemothrapy and to assess the clinical features and treatment of IP.Methods： A clinical study was conducted on 266 cases of CD20＋ B-NHL patients with CHOP- like or RCHOP- like therapeutic regimen from January 2010 to May 2015. The cases were divided into rituximab-containing chemotherapy group and chemotherapy group. We analyzed the relationship between the development of IP and the use of rituximab. The IP related clinical features were also reviewed.Results： The incidence of IP in the rituximab-containing chemotherapy group was significantly higher compared with the incidence in the chemotherapy group. The IP- related factors include age〉60, male, elevated absolute lymphocyte count（ALC）, diabetes, and diffuse larpe B- cell lymphoma（DLBCL） subtype. By multivariate analysis, elevated ALC, diabetes, DLBCL subtype, and addition of rituximab were revealed as significant factors for an elevated risk of IP. Conclusion： The incidence of IP was higher in patients with CD20＋ BNHL receiving rituximab-containing chemotherapy; this result may be related to immune disorders. Corticosteroids and antifungal therapy can effectively relieve the patients’ symptoms.

关 键 词：B细胞非霍奇金淋巴瘤 利妥昔单抗 间质性肺炎 危险因素 治疗 

分 类 号：R733.1[医药卫生—肿瘤]