乙型肝炎病毒感染在弥漫性大B细胞淋巴瘤患者中的再激活与预后的关系  

Relationship between reactivation of hepatitis B virus infection and prognosis in patients with diffuse large B-cell lymphoma

作　　者：徐雪丹 夏平方[1] 梁玉环[1] 梁惠如[1] 陈荣伴[1] Xu Xuedan;Xia Pingfang;Liang Yuhuan;Liang Huiru;Chen Rongban(Department of Hematology,Jiangmen Central Hospital,Jiangmen 529000,Guangdong,China)

机构地区：[1]广东省江门市中心医院血液科

出　　处：《右江民族医学院学报》2020年第1期30-34,共5页Journal of Youjiang Medical University for Nationalities

摘　　要：目的探索乙型肝炎病毒(HBV)相关和非HBV相关的弥漫性大B细胞淋巴瘤(DLBCL)的临床特征和生存差异,评估DLBCL患者HBV再激活的相关危险因素。方法选取2010年1月-2015年12月广东省江门市中心医院诊治的134例被诊断为CD20+DLBCL的患者。多变量Logistic回归分析HBV再激活的预测因子。采用Kaplan-Meier方法探索HBsAg阳性和HBsAg阴性患者之间的生存差异。结果在入组的患者中,26例患者HBsAg血清阳性,108例患者HBsAg血清阴性。统计结果显示,HBsAg阴性患者的年龄显著高于HBsAg血清阳性患者(P=0.035)。在治疗后,HBsAg阴性组的完全缓解率、部分缓解率、疾病稳定率和疾病进展率分别为63.89%,16.67%,0.93%和18.51%,显著高于HBsAg血清阳性组(P=0.007)。Kaplan-Meier分析显示,HBsAg阴性的DLBCL患者预后较好(P=0.009)。一共有11例HBsAg阴性患者治疗后出现HBV再激活。在HBV激活的患者中,HBsAb阴性比例显著高于HBV非激活的患者(P <0.001)。多变量分析显示,HBsAb是保护因素,而阳性HBcAb是DLBCL患者HBV再激活的独立危险因素。结论 HBV相关DLBCL患者的特征和预后差于非HBV相关的DLBCL患者。HBsAb阴性/HBcAb阳性患者在接受利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和强的松(R-CHOP)化疗后发生HBV再激活的风险更高。Objective To explore the clinical features and survival differences between hepatitis B virus(HBV)-related and non-HBV-related diffuse large B-cell lymphoma(DLBCL),and to evaluate the risk factors associated with HBV reactivation in patients with DLBCL. Methods A total of 134 patients diagnosed with CD20+DLBCL and treated at Guangdong Jiangmen Central Hospital from January 2010 to December 2015 were enrolled in this study.Multivariate Logistic regression analysis was used to determine predictors of HBV reactivation.The Kaplan-Meier method was used to explore the survival difference between positive HBsAg and negative HBsAg patients. Results Out of the patients enrolled,26 were diagnosed with HBsAg seropositive and108 with HBsAg seronegative.The results showed that the HBsAg-negative patients was significantly older than the HBsAg-positive patients(P =0.035).After treatment,the complete response rate,partial response rate,disease stable and disease progression rate of HBsAg-negative group were 63.89%,16.67%,0.93% and18.51%,respectively,which were significantly higher than those of HBsAg-positive group(P =0.007).Kaplan-Meier analysis showed that patients with HBsAg-negative DLBCL had a better prognosis(P =0.009).A total of 11 HBsAg-negative patients developed HBV reactivation after treatment.The HBsAb-negative rate in HBV-activated patients was significantly higher than that in HBV-inactivated patients(P <0.001).Multivariate analysis showed that HBsAb was protective factor,and positive HBcAb was independent risk factor for HBV reactivation in patients with DLBCL. Conclusion The characteristics and prognosis of HBV-associated DLBCL patients are significantly worse than those of non-HBV-related DLBCL patients.HBsAb-negative/HBcAb-positive patients have a higher risk of HBV reactivation after receiving Rituximab combined with Cyclophosphamide,Doxorubicin,Vincristine and Prednisone(R-CHOP)chemotherapy.

关 键 词：乙肝病毒 弥漫性大B细胞淋巴瘤 利妥昔单抗 HBV再激活 危险因素 

分 类 号：R373.21[医药卫生—病原生物学]