营养控制状态评分对初治弥漫大B细胞淋巴瘤老年患者预后的预测价值  

Predictive value of controlling nutritional status score in prognosis of naive elderly patients with diffuse large B-cell lymphoma

作　　者：马盼盼 刘依 冯慧 李欣妍 雷豆 刘海波[1] 牛凡 王晓宁[1] 罗敏娜[1] 贺鹏程[1] Ma Panpan;Liu Yi;Feng Hui;Li Xinyan;Lei Dou;Liu Haibo;Niu Fan;Wang Xiaoning;Luo Minna;He Pengcheng(Department of Hematology,First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,Shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院血液内科,710061

出　　处：《国际输血及血液学杂志》2021年第2期138-147,共10页International Journal of Blood Transfusion and Hematology

基　　金：国家重点研发计划资助项目(2019YFC1316204);陕西省自然科学基础研究计划项目(2018ZDCXL-SF-01-02-01);"重大新药创制"科技重大专项(2020ZX09201020)。

摘　　要：目的探讨营养控制状态(CONUT)评分对初治弥漫大B细胞淋巴瘤(DLBCL)老年患者预后的预测价值。方法选择2013年1月至2018年12月,于西安交通大学第一附属医院收治的129例初治DLBCL老年患者(≥60岁)为研究对象。患者中位年龄为66岁(60~83岁);男性患者为75例,女性为54例。回顾性分析患者的临床资料,根据化疗前的血清白蛋白值、血清总胆固醇(TC)水平、淋巴细胞(Lym)计数计算CONUT评分,采取受试者工作特征(ROC)曲线计算CONUT评分对患者生存结局预测的最佳临界值,并且根据最佳临界值将患者分为高、低CONUT评分组。组间年龄、B症状、Ann Arbor分期等不同临床特征的构成比比较,采用χ^(2)检验。采用Kaplan-Meier法绘制不同临床特征患者的总体生存(OS)曲线,并且计算其3年OS率。采用log-rank检验对可能影响本研究DLBCL老年患者OS率的因素进行单因素分析,采用多因素Cox比例风险回归模型,对单因素分析结果中有统计学意义的影响因素进行多因素分析。本研究遵循的程序符合2013年修订版《世界医学协会赫尔辛基宣言》要求,并且与所有受试者签署临床研究知情同意书。结果①通过ROC曲线确定CONUT评分预测DLBCL老年患者生存结局的最佳临界值为3.5分,其敏感度为71.4%,特异度为60.0%,ROC曲线的曲线下面积(AUC)为0.705(95%CI:0.614~0.795)。②根据CONUT评分的最佳临界值,将129例患者分为高CONUT评分(n=78,CONUT评分≥3.5分)和低CONUT评分组(n=51,CONUT评分<3.5分),2组患者的年龄、B症状、Ann Arbor分期、化疗前血红蛋白(Hb)值、化疗前血清乳酸脱氢酶(LDH)水平、国际预后指数(IPI)评分构成比分别比较,差异均有统计学意义(χ^(2)=4.575、7.382、15.656、15.530、7.696、17.808,P=0.032、0.007、<0.001、<0.001、0.006、<0.001)。③对可能影响本研究129例DLBCL老年患者OS率的因素进行单因素分析结果显示,年龄、是否伴B症状、Ann Arbor分期�Objective To investigate the predictive value of controlling nutritional status(CONUT)score in prognosis of naive elderly patients with diffuse large B-cell lymphoma(DLBCL).Methods From January 2013 to December 2018,a total of 129 elderly patients with DLBCL who were first treated in Department of Hematology,First Affiliated Hospital of Xi′an Jiaotong University were selected as research subjects.The median age of patients was 66 years.And there were 75 male patients and 54 females.Retrospectively analyzed the patient′s clinical data,and obtained the CONUT score based on the patient′s serum ablumin value,serum fofal cholesterol(TC)level,and lymphocyte(Lym)count before chemotherapy.And through receiver operating characteristic(ROC)curve,CONUT score of the best cut-off value was obtained,then patients were divided into high and low CONUT score groups according to the best cut-off value of CONUT score.The composition ratio of different clinical features between groups was compared using the Chi-square test.Log-rank test was used to conduct a univariate analysis of OS rate in elderly patients with DLBCL,and then a multivariate Cox proportional hazard model was used for multivariate analysis with the influencing factors in univariate analysis results with statistical significance.This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from the subjects.Results①According to ROC curve,the best cut-off value of CONUT score for survival outcome of patients was 3.5 scores,sensitivity was 71.4%,specificity was 60.0%,and ROC-area under curve(AUC)was 0.705(95%CI:0.614-0.795).②Patients were divided into high CONUT score group(CONUT score≥3.5 scores,n=78)and low CONUT score group(CONUT score<3.5 scores,n=51).By comparing composition ratio of age,B symptoms,Ann Arbor staging,hemoglobin(Hb)value before chemotherapy,serum lactate dehydrogenase(LDH)level before chemotherapy,and international prognostic index(IPI)score between patients two groups,t

关 键 词：淋巴瘤 大B细胞 弥漫性 营养不良 预后 危险因素 营养控制状态评分 老年人 

分 类 号：R733.1[医药卫生—肿瘤]