血常规和血生化指标对弥漫大B细胞淋巴瘤患者免疫治疗联合化疗相关间质性肺炎的预测价值  

Predictive value of blood routine and blood biochemical indicators for immunotherapy combined with chemotherapy-related interstitial pneumonia in patients with diffuse large B-cell lymphoma

作　　者：夏凡[1] 包其 朱建国[2] 金正明[1] 缪丽燕[1] 吴德沛[2] 曲昌菊[2] Xia Fan;Bao Qi;Zhu Jianguo;Jin Zhengming;Miao Liyan;Wu Depei;Qu Changju(Department of Pharmacy,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Hematology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院药学部,江苏苏州215006 [2]苏州大学附属第一医院血液科,江苏苏州215006

出　　处：《白血病．淋巴瘤》2021年第10期593-598,共6页Journal of Leukemia & Lymphoma

摘　　要：目的探讨血常规和血生化指标对弥漫大B细胞淋巴瘤(DLBCL)免疫治疗联合化疗相关间质性肺炎(IP)的预测价值。方法回顾性分析2017年12月至2020年10月苏州大学附属第一医院收治的接受利妥昔单抗联合化疗治疗的初治DLBCL患者151例,根据是否发生IP,将患者分为IP组和非IP组。收集患者的临床资料及基线实验室检查结果,分析IP组和非IP组间临床病理特征和实验室指标的差异;对血常规及血生化指标的变化与IP的发生关系进行分析。绘制筛选的指标预测IP发生的受试者工作特征(ROC)曲线,分析各指标预测效能。结果DLBCL患者接受免疫治疗联合化疗治疗后IP的发生率为9.3%(14/151)。初诊时IP组淋巴细胞计数(LYM)高于非IP组[1.60×10^(9)/L(1.40×10^(9)/L,2.51×10^(9)/L)比1.28×10^(9)/L(0.89×10^(9)/L,1.78×10^(9)/L),U=-2.194,P=0.028],两组血小板计数、中性粒细胞计数、单核细胞计数、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、血清清蛋白(ALB)水平及C反应蛋白(CRP)升高患者比例差异均无统计学意义(均P>0.05)。与非IP组第4个周期治疗前比较,IP组发生IP时的LYM和ALB降低[0.72×10^(9)/L(0.46×10^(9)/L,0.92×10^(9)/L)比0.93×10^(9)/L(0.71×10^(9)/L,1.15×10^(9)/L),32.9 g/L(28.6 g/L,34.9 g/L)比40.3 g/L(36.1 g/L,43.1 g/L)],LDH和α-HBDH升高[332 U/L(255 U/L,396 U/L)比233 U/L(200 U/L,286 U/L),277 U/L(206 U/L,315 U/L)比189 U/L(159 U/L,229 U/L)],差异均有统计学意义(均P<0.05),IP组CRP升高患者比例较非IP组高[100.0%(14/14)比56.9%(78/137),P=0.001]。LYM、ALB、LDH、α-HBDH单独预测IP发生的ROC曲线下面积分别为0.668、0.820、0.789和0.802,ALB、LDH和α-HBDH的最佳临界值分别为34.6 g/L、241 U/L、199 U/L,ALB预测IP发生的灵敏度最高(81.8%);ALB+LDH、ALB+α-HBDH、LDH+α-HBDH、ALB+LDH+α-HBDH预测IP发生的ROC曲线下面积分别为0.850、0.844、0.777、0.851,LDH+α-HBDH预测灵敏度最高(92.9%),但特异度低(53.3%),ALB+LDH、ALB+LDH+α-HBDHObjective To investigate the predictive value of blood routine and blood biochemical indicators for immunotherapy combined with chemotherapy-related interstitial pneumonia(IP)in patients with diffuse large B-cell lymphoma(DLBCL).Methods The data of 151 newly-diagnosed DLBCL patients treated with rituximab combined with chemotherapy in the First Affiliated Hospital of Soochow University from December 2017 to October 2020 were retrospectively analyzed.According to whether IP occurred,the patients were divided into IP group and non-IP group.The patient's clinical data and baseline laboratory test results were collected.The differences in clinicopathological features and laboratory indicators between IP group and non-IP group were analyzed.In addition,the relationship between the variety of blood routine and blood biochemical indicators and the occurrence of IP was analyzed.The receiver operating characteristic(ROC)curve of the selected indicators to predict the occurrence of IP was drawn,and the predictive performance of each indicator was analyzed.Results The incidence of IP was 9.3%(14/151)in DLBCL patients after receiving immunotherapy combined with chemotherapy.The lymphocyte count(LYM)in IP group at the first diagnosis was higher than that in non-IP group[1.60×10^(9)/L(1.40×10^(9)/L,2.51×10^(9)/L)vs.1.28×10^(9)/L(0.89×10^(9)/L,1.78×10^(9)/L),U=-2.194,P=0.028],but there was no significant difference in the levels of platelet count,neutrophil count,monocyte count,lactate dehydrogenase(LDH),α-hydroxybutyrate dehydrogenase(α-HBDH),serum albumin(ALB)and the proportion of patients with elevated C-reactive protein(CRP)between the two groups(all P>0.05).Compared with the laboratory indicators in non-IP group before the 4th cycle of treatment,LYM and ALB in IP group were significantly reduced at IP onset[0.72×10^(9)/L(0.46×10^(9)/L,0.92×10^(9)/L)vs.0.93×10^(9)/L(0.71×10^(9)/L,1.15×10^(9)/L),32.9 g/L(28.6 g/L,34.9 g/L)vs.40.3 g/L(36.1 g/L,43.1 g/L)],but LDH andα-HBDH increased[332 U/L(255 U/L,396 U/L)vs.23

关 键 词：淋巴瘤 大B-细胞 弥漫性 肺疾病 间质性 免疫疗法 抗肿瘤联合化疗方案 血象 血液蛋白 ROC曲线 

分 类 号：R733.1[医药卫生—肿瘤]