D-二聚体水平在初诊弥漫大B细胞淋巴瘤患者预后评估中的价值  

Prognostic value of D⁃dimer level in patients with newly diagnosed diffuse large B⁃cell lymphoma

作　　者：张廷 宋腾[1] 陈馨蕊 李琳[1] 齐瑞丽 赵可 乔薇 柳凤亭 王华庆[1] Zhang Ting;Song Teng;Chen Xinrui;Li Lin;Qi Ruili;Zhao Ke;Qiao Wei;Liu Fengting;Wang Huaqing(Medical Oncology Center,Tianjin People's Hospital,Tianjin Cancer Research Institute of Traditional Chinese and Western Medicine,Tianjin 300121,China)

机构地区：[1]天津市人民医院肿瘤诊治中心,天津市中西医结合肿瘤研究所,300121

出　　处：《白血病．淋巴瘤》2021年第3期151-155,共5页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金(8207010175)。

摘　　要：目的探讨D-二聚体水平在弥漫大B细胞淋巴瘤(DLBCL)患者中的预后意义。方法回顾性分析2015年1月至2019年6月天津市人民医院收治的70例初诊DLBCL患者的临床资料,根据受试者工作特征(ROC)曲线确定D-二聚体判断患者生存的最佳截断值,并将患者分组。比较不同D-二聚体水平患者间凝血相关指标及临床病理特征差异;采用Kaplan-Meier法对总生存(OS)进行单因素分析,采用Cox回归模型进行OS多因素分析。结果根据ROC曲线,D-二聚体判断患者生存的最佳截断值为0.75 mg/L。D-二聚体≥0.75 mg/L组(36例)和<0.75 mg/L组(34例)中不同临床分期、国际预后指数评分、乳酸脱氢酶水平的患者比例比较,差异均有统计学意义(均P<0.05);血浆凝血酶原时间分别为(13.5±0.9)s和(13.0±0.8)s,活化部分凝血活酶时间分别为(37±5)s和(34±6)s,差异均有统计学意义(均P<0.05)。单因素生存分析显示,Ann Arbor分期Ⅲ~Ⅳ期、国际预后指数评分>2分、乳酸脱氢酶水平>240 U/L、有B症状、D-二聚体水平≥0.75 mg/L DLBCL患者5年OS率均降低(均P<0.05)。多因素Cox回归分析显示,D-二聚体≥0.75 mg/L为DLBCL患者OS独立危险因素(HR=0.368,95%CI 0.144~0.944,P=0.038)。结论D-二聚体水平可作为判断DLBCL患者预后的临床指标,D-二聚体水平高患者预后不良。Objective To investigate the prognostic significance of D-dimer level in patients with diffuse large B-cell lymphoma(DLBCL).Methods The clinical data of 70 newly diagnosed DLBCL patients who were admitted to Tianjin People′s Hospital from January 2015 to June 2019 were retrospectively analyzed.The optimal cut-off value of D-dimer for survival was determined according to the receiver operating characteristic(ROC)curve,and the patients were grouped.The differences of coagulation related indexes and clinicopathological features between patients with different D-dimer levels were compared.Kaplan-Meier method was used for univariate analysis of overall survival(OS),and Cox regression model was used for multivariate analysis of OS.Results According to ROC curve,the best cut-off value of D-dimer for survival was 0.75 mg/L.The proportion of patients with different clinical staging,international prognostic index score,lactate dehydrogenase level had statistically significant differences between the D-dimer≥0.75 mg/L group(36 cases)and<0.75 mg/L group(34 cases)(all P<0.05).The prothrombin time of D-dimer≥0.75 mg/L group and<0.75 mg/L group were(13.5±0.9)s and(13.0±0.8)s,respectively,and the activated partial thromboplastin time were(37±5)s and(34±6)s,respectively,and the differences were statistically significant(all P<0.05).Univariate analysis showed that the 5-year OS rates of DLBCL patients with Ann Arbor stageⅢ-Ⅳ,international prognostic index score>2,lactate dehydrogenase level>240 U/L,B symptoms,D-dimer level≥0.75 mg/L were decreased(all P<0.05).Multivariate Cox regression analysis showed that D-dimer≥0.75 mg/L was an independent risk factor for OS of DLBCL patients(HR=0.368,95%CI 0.144-0.944,P=0.038).Conclusion The level of D-dimer can be used as a clinical indicator to judge the prognosis of DLBCL patients,and the prognosis of patients with high D-dimer level is poor.

关 键 词：淋巴瘤 大B-细胞 弥漫性 D-二聚体 预后 

分 类 号：R733.1[医药卫生—肿瘤]