伴单克隆免疫球蛋白淋巴瘤患者临床特征及预后分析  

Clinical features and prognosis of lymphoma patients with monoclonal immunoglobulin

作　　者：唐潇 邹文蓉[1] 彭鹏 白洋禄 芮红兵[2] Tang Xiao;Zou Wenrong;Peng Peng;Bai Yanglu;Rui Hongbing(Department of Hematology,Sichuan Mianyang 404 Hospital,Mianyang 621000,China;Department of Hematology,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]四川绵阳四〇四医院血液科,621000 [2]福建医科大学附属第一医院血液科,福州350005

出　　处：《白血病．淋巴瘤》2020年第9期546-549,共4页Journal of Leukemia & Lymphoma

基　　金：四川省医学会科研基金(S17058)。

摘　　要：目的:分析伴单克隆免疫球蛋白(McIg)淋巴瘤患者的临床特征及预后。方法:回顾性分析2014年1月至2019年1月福建医科大学附属第一医院14例经病理确诊为淋巴瘤且伴McIg患者的资料,同时选择40例不伴McIg淋巴瘤患者作为对照,对患者年龄、性别、国际预后指数(IPI)评分、B症状、D-二聚体、肿瘤细胞来源、Ki-67等进行预后单因素分析。采用Kaplan-Meier法进行生存分析,比较两组患者的总生存(OS)及无进展生存(PFS)情况。结果:14例伴McIg淋巴瘤患者中,男性6例,女性8例,中位发病年龄63岁(42~78岁),临床分期Ⅲ~Ⅳ期13例,存在结外病变12例,最常见的McIg类型为IgM-κ型。单因素分析结果显示,IPI评分≥3分、D-二聚体升高与预后不良有关(均P<0.05)。截至随访结束,伴McIg淋巴瘤患者中位OS时间未达到,2年OS率为64.3%,中位PFS时间为16个月;不伴McIg淋巴瘤患者中位OS时间未达到,2年OS率为90.8%,中位PFS时间为37个月;两组OS差异有统计学意义(P=0.040)。结论:伴McIg的淋巴瘤患者多有结外侵犯,临床分期多为Ⅲ、Ⅳ期,IPI评分≥3分、D-二聚体升高提示预后不良。McIg的分泌是淋巴瘤患者预后不良的重要因素。Objective To analyze the clinical features and prognosis of lymphoma patients with monoclonal immunoglobulin(McIg).Methods The data of 14 patients who were pathologically diagnosed as lymphoma and with McIg in the First Affiliated Hospital of Fujian Medical University from January 2014 to January 2019 were retrospective analyzed.At the same time,40 lymphoma patients without McIg were sellected as controls.The patients'age,gender,international prognostic index(IPI)score,B symptoms,tumor cell source and Ki-67 index were analyzed by prognostic single factor analysis.Kaplan-Meier method was used for survival analysis,and the overall survival(OS)and progression-free survival(PFS)were compared between the two groups.Results Among 14 lymphoma patients with McIg,6 were males and 8 were females.The median age of onset was 63 years(42-78 years).There were 13 cases of clinical stageⅢ-Ⅳ,and 12 cases of extranodal disease.The most common type was IgM-κ.The results of univariate analysis showed that IPI score≥3 points and elevated D-dimer level were related to poor prognosis(both P<0.05).At the end of follow-up,the median OS time of lymphoma patients with McIg had not reached,the 2-year OS rate was 64.3%,and the median PFS time was 16 months;the median OS time of lymphoma patients without McIg had not reached,the 2-year OS rate was 90.8%,and the median PFS time was 37 months;the difference of OS between the two groups was statistically significant(P=0.040).Conclusions Most lymphoma patients with McIg have extranodal involvement,the clinical stage is more inclined to stageⅢ-Ⅳ,IPI score≥3 points and elevated D-dimer level are poor prognostic factors.The secretion of McIg is an important factor for the poor prognosis of patients with lymphoma.

关 键 词：淋巴瘤 免疫球蛋白类 临床特征 预后 

分 类 号：R733.1[医药卫生—肿瘤]