可溶性B7-H3在继发性噬血细胞性淋巴组织细胞增多症患者中的表达及临床意义  

Expression and Clinical Significance of Soluble B7-H3 in Patient with Secondary Hemophagocytic Lymphohistiocytosis

作　　者：吕鑫[1,2] 王越 王菱菱 尹光丽[1] 刘玲玲 段丽敏[3] 田甜[3] 许戟[3] 仇红霞[1] LYU Xin;WANG Yue;WANG Ling-Ling;YIN Guang-Li;LIU Ling-Ling;DUAN Li-Min;TIAN Tian;XU Ji;QIU Hong-Xia(Department of Hematology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,Jiangsu province,China;Department of Hematology,Linyi Central Hosiptal,Yishui 276400,Shandong Province,China;Department of Geriatric Hematology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital.Nanjing 210029,Jiangsu province,China)

机构地区：[1]南京医科大学第一附属医院、江苏省人民医院血液科,江苏南京210029 [2]山东省临沂市中心医院血液科,山东沂水276400 [3]江苏省人民医院老年血液科,江苏南京210029

出　　处：《中国实验血液学杂志》2020年第3期1006-1011,共6页Journal of Experimental Hematology

基　　金：国家自然科学基金(81570175)。

摘　　要：目的:探讨可溶性B7-H3(sB7-H3)在继发性噬血细胞性淋巴组织细胞增多症(sHLH)患者中的诊断及预后意义。方法:收集2012年12月至2018年4月收治的85例初诊sHLH患者初次就诊时的血浆标本,并按照病因将患者分为淋巴瘤相关HLH(LHLH)组和感染相关HLH(IHLH)组。应用ELISA实验检测患者血浆中sB7-H3的表达,同时收集患者的临床资料进行分析并以15例健康体检者为对照组。结果:与对照组相比较,淋巴瘤相关HLH组和感染相关HLH组sB7-H3的表达均明显升高(P<0.05),淋巴瘤相关HLH组sB7-H3的表达明显高于感染相关HLH组((35.75±9.90)vs(28.70±8.95)ng/ml)(P<0.001)。淋巴瘤相关HLH组与感染相关HLH组患者部分临床指标(包括年龄、发热、脾肿大、ANC、Plt、FIB、钙离子、血清白蛋白、LDH、血清铁蛋白、sCD25)的表达均无明显统计学差异(P>0.05)。应用ROC曲线评价sB7-H3在sHLH的表达及意义结果显示,在与感染相关HLH患者的对比中,ROC(AUC)曲线下面积为0.718(95%CI0.610-0.810)(P=0.0002),预测淋巴瘤相关HLH患者的敏感性和特异性分别为77.36%和59.38%。ROC曲线分析sB7-H3的最佳cut-off值为29.81 ng/ml,sB7-H3高表达组(≥29.81 ng/ml)总生存中位时间较低表达组(<29.81 ng/ml)明显缩短(24 vs 440 d)(P<0.001)。影响sHLH患者生存状态的临床指标分别是中性粒细胞、白蛋白、血清铁蛋白、血清钙离子和sB7-H3水平。结论:sB7-H3与sHLH影响不良预后的相关因素并可能参与疾病进展。Objective:To investigate the expression and clinical significance of soluble B7-H3(sB7-H3)in patients with secondary hemophagocytic lymphohistiocytosis(sHLH).Methods:The plasma samples of 85 newly diagnosed sHLH patients from December 2012 to April 2018 were collected.The patients were divided into lymphoma-related HLH(LHLH)group and infection-related HLH(IHLH)group.The expression of sB7-H3 in plasma was detected by ELISA,and the clinical data were collected for analysis.Fifteen healthy people were chosen as control group.Results:The expression level of sB7-H3 in lymphoma-related HLH and infection-related HLH group significant increased as compared with the control group,(P<0.05),and the expression level of sB7-H3 in lymphoma-related HLH group was significant higher than that in infection-related HLH group[(35.75±9.90)vs(28.70±8.95)ng/ml)](P<0.001).There were no significant statistical difference in the expression of some clinical factors(including age,fever,splenomegaly,ANC,Plt,FIB,calcium ion,serum albumin,LDH,serum ferritin,sCD25)in lymphoma-related HLH and infectionrelated HLH group(P>0.05).The evaluation of expression and significance of sB7-H3 in sHLH by using ROC curve,showed that the area under ROC curve comparison of patients in lymphoma-related HLH group and infection-related HLH group was 0.718(95%CI 0.610-0.810)(P=0.0002),and predicting the sensitivity and specificity of the lymphomarelated HLH patients were 77.36%and 59.38%,respectively.The best cut-off value of patients in sB7-H3 was 29.81 ng/ml,the overall survival time of sB7-H3 high-expression group(≥29.81 ng/ml)was significant shorter than that in lowexpression group(<29.81 ng/ml)(24 vs 440 d)(P<0.001).The clinical factors affecting the survival status of sHLH patients were neutrophils,albumin,serum ferritin,serum calcium ions and sB7-H3 levels.Conclusion:sB7-H3 associates with poor prognosis of sHLH patients,and may be involved in disease progression.

关 键 词：继发性噬血细胞性淋巴组织细胞增多症 可溶性B7-H3 预后 

分 类 号：R733.4[医药卫生—肿瘤]