B细胞非霍奇金淋巴瘤R-CHOP样方案治疗相关间质性肺炎发生情况及影响因素分析  

Analysis of incidence and influencing factors of R-CHOP-like regimen treatment-related interstitial pneumonia in B-cell non-Hodgkin lymphoma

作　　者：郑鸿 崔冉 李雪莲 祝子华 Zheng Hong;Cui Ran;Li Xuelian;Zhu Zihua(Department of Chemotherapy,Minhang Branch of Fudan University Shanghai Cancer Hospital,Shanghai 200240,China;Department of Gastroenterology,Minhang Branch of Fudan University Zhongshan Hospital,Shanghai 201199,China)

机构地区：[1]复旦大学附属肿瘤医院闵行分院化疗科,上海200240 [2]复旦大学附属中山医院闵行分院消化科,上海201199

出　　处：《白血病．淋巴瘤》2020年第7期405-409,共5页Journal of Leukemia & Lymphoma

摘　　要：目的探讨B细胞非霍奇金淋巴瘤(B-NHL)患者应用R-CHOP样方案化疗后发生间质性肺炎(IP)的相关影响因素。方法回顾性分析复旦大学附属肿瘤医院闵行分院2014年1月至2019年6月377例CD20阳性B-NHL患者的临床资料,依据是否应用利妥昔单抗将患者分为R-CHOP样化疗组(275例)和CHOP样化疗组(102例)。分析依据不同临床相关因素分层患者的IP发生情况,采用logistic多因素回归分析法分析影响IP发生的危险因素。结果377例患者中38例(10.08%)发生IP;R-CHOP样化疗组和CHOP样化疗组IP的发生率分别为13.09%(36/275)、1.96%(2/102),差异有统计学意义(χ^2=10.169,P<0.01)。是否应用利妥昔单抗、方案中是否有脂质体多柔比星以及治疗过程中是否出现Ⅳ级中性粒细胞减少患者的IP发生率差异均有统计学意义[13.09%(36/275)比1.96%(2/102),18.18%(22/121)比6.25%(16/256),15.43%(27/175)比5.45%(11/202),均P<0.01]。logistic回归分析显示,应用利妥昔单抗(OR=6.761,95%CI 1.369~33.711,P=0.020)及Ⅳ级中性粒细胞减少(OR=7.443,95%CI 2.132~8.199,P=0.001)是影响IP发生的独立危险因素。结论在B-NHL患者中R-CHOP样方案化疗增加了IP的发生;应用利妥昔单抗、Ⅳ级中性粒细胞减少是发生IP的独立危险影响因素。Objective To explore the related influencing factors of interstitial pneumonia(IP)in B-cell non-Hodgkin lymphoma(B-NHL)patients treated with R-CHOP-like chemotherapy regimen.Methods The clinical data of 377 CD20+B-NHL patients in Minhang Branch of Fudan University Shanghai Cancer Hospital from January 2014 to June 2019 were retrospectively analyzed.According to whether rituximab was used,patients were divided into R-CHOP-like chemotherapy group(275 cases)and CHOP-like chemotherapy group(102 cases).The incidence of IP in patients stratified according to different clinical factors was analyzed,and logistic multivariate regression was used to analyze the risk factors of IP.Results Thirty-eight out of 377 patients(10.08%)developed IP;the incidence rates of IP in the R-CHOP-like chemotherapy group and the CHOP-like chemotherapy group were 13.09%(36/275)and 1.96%(2/102),respectively,and the difference was statistically significant(χ^2=10.169,P<0.01).There were statistical differences in the incidence rates of IP between patients with or without rituximab,with or without liposomal doxorubicin in the regimen,and with or without gradeⅣneutropenia occurred during the treatment[13.09%(36/275)vs.1.96%(2/102),18.18%(22/121)vs.6.25%(16/256),15.43%(27/175)vs.5.45%(11/202),all P<0.01].Logistic regression analysis showed that the application of rituximab(OR=6.761,95%CI 1.369-33.711,P=0.020)and gradeⅣneutropenia(OR=7.443,95%CI 2.132-8.199,P=0.001)were independent risk factors for the occurrence of IP.Conclusions R-CHOP-like chemotherapy regimen increases the occurrence of IP in patients with B-NHL.The use of rituximab and gradeⅣneutropenia are independent risk factors for the occurrence of IP.

关 键 词：淋巴瘤 非霍奇金 淋巴瘤 B细胞 肺疾病 间质性 药物疗法 联合 利妥昔单抗 

分 类 号：R733.1[医药卫生—肿瘤] R563.1[医药卫生—临床医学]