慢性淋巴细胞白血病503例临床及实验室特征回顾性分析  

Clinical and laboratory features of B-cell chronic lymphocytic leukemia： a retrospective analysis of 503 cases

作　　者：李姮[1] 熊文婕[1] 刘慧敏[1] 易树华[2] 吕瑞[2] 王婷玉[2] 于珍[1] 邱录贵[2] 李增军[1] 

机构地区：[1]中国医学科学院北京协和医学院血液学研究所血液病医院实验血液学国家重点实验室,天津300020 [2]中国医学科学院北京协和医学院血液学研究所血液病医院淋巴瘤诊疗中心,天津300020

出　　处：《白血病．淋巴瘤》2017年第6期325-330,共6页Journal of Leukemia & Lymphoma

基　　金：天津市应用基础与前沿技术研究计划（15JCYBJC27900）

摘　　要：目的 探讨慢性淋巴细胞白血病（CLL）患者的临床及主要实验室特征.方法 回顾性分析1998年10月至2015年2月收治的503例CLL患者的临床及实验室检查资料,应用χ2检验进行差异性检验,并利用Log-rank法检验各组患者生存率的差异.结果 503例CLL患者中位年龄58岁（26~86岁）,男性335例,女性168例.初诊时临床分期以Binet A期为主,为204例（40.5%）,其次为Binet B期和C期,分别为148例（30.1%）和151例（29.3%）.初诊时108例（21.1%）患者存在贫血（血红蛋白〈100 g/L）;427例进行血清乳酸脱氢酶检测的患者中,有113例（26.5%）升高;344例进行CD38检测的患者中有100例（29.1%）表达阳性.330例具有完整荧光原位杂交（FISH）资料的患者中,156例（47.3%）伴13q缺失（13q-）,为检出率最高的细胞遗传学异常;其次为IgH易位（22.4%）,12号染色体三体（＋12,21.2%）和17p缺失（17p-,14.5%）.在230例进行免疫球蛋白重链可变区（IGHV）突变状态检测的患者中,165例（71.7%）IGHV为突变状态,表达V4-34基因的患者比例最高,占12.4%（28例）.中位无进展生存（PFS）时间为89.0个月（95%CI 75.0~103.0个月）,中位总生存（OS）时间为129.0个月（95%CI 106.9~151.1个月）.结论与欧美国家的CLL患者相比,本组CLL患者发病年龄偏低,总体生存期较长,一定程度上反映了我国CLL患者的特点.Objective To investigate the clinical and laboratory characteristics of patients with chronic lymphocytic leukemia （CLL）. Methods 503 patients with CLL admitted from October 1998 to February 2015 were retrospectively analyzed. Baseline characteristics were compared using Chi-square test and Kaplan-Meier methodology was undertaken for survival analyses. Results The median age was 58 years （26-86 years）：335 cases were male and 168 cases were female. 204 cases （40.5%） were at the clinical stage of Binet A, followed by Binet B （148 cases, 30.1%） and Binet C （151 cases, 29.3%）. 108 cases （21.1%） had anemia at diagnosis, while 113 cases （26.5 %） had an elevated level of lactate dehydrogenase and the expression of CD38 was detected among 100 cases （29.1 %）. Clonal abnormalities were observed using fluorescence in situ hybridization （FISH） analysis. Those involving 13q deletion were the most frequent （156 cases, 47.3 %）, followed by IgH translocation （22.4 %）, trisomy 12 （21.2 %） and 17p deletion （14.5 %）. The mutational status of immunoglobulin heavy chain variable region was determined among 230 cases, 165 cases （71.7%） of which were found to be with mutated status. The most frequently encountered gene was V4-34 （28 cases, 12.4 %）. The median progression-free survival （PFS） was 89.0 months （95 %CI 75.0-103.0 months）, while the median overall survival was 129.0 months （95 %CI 106.9-151.1 months）. Conclusion Compared with patients in the western world, CLL patients in this study are younger at diagnosis and have longer overall survival, which, to some extent, could reflects the characteristics of CLL patients in China.

关 键 词：白血病 淋巴细胞 慢性 细胞遗传学 临床特征 

分 类 号：R733.72[医药卫生—肿瘤]