治疗前血浆纤维蛋白原水平在弥漫大B细胞淋巴瘤患者预后判断中的价值  

Value of plasma fibrinogen level before treatment in prognosis of patients with diffuse large B-cell lymphoma

作　　者：黄豪博[1] 黄晓玲 范丽萍[1] 林秋燕[1] 付丹晖[1,2] HUANG Haobo;HUANG Xiaoling;FAN Liping;LIN Qiuyan;FU Danhui(Department of Blood Transfusion,Fujian Medical University Union Hospital,Fuzhou,350001,China;Department of Hematology,Fujian Medical University Union Hospital)

机构地区：[1]福建医科大学附属协和医院输血科,福州350001 [2]福建医科大学附属协和医院血液科

出　　处：《临床血液学杂志》2022年第1期58-62,共5页Journal of Clinical Hematology

基　　金：福建省自然科学基金资助(No:2020J01992);福建省科技创新联合资金项目(No:2019Y9050);福建省医学创新课题(No:2018-CXB-7,2019-CX-15)。

摘　　要：目的:探讨治疗前血浆纤维蛋白原(Fib)水平在初治弥漫大B细胞淋巴瘤(DLBCL)患者预后判断中的价值。方法:回顾性分析符合入选标准的389例初治DLBCL患者治疗前血浆Fib水平与患者临床病理特征及预后的关系。采用受试者工作特征曲线确定治疗前血浆Fib截断值,按截断值将患者分为Fib高水平组(245例)和Fib低水平组(144例)。比较2组患者临床病理特征、总生存期(OS)及疾病无进展生存期(PFS)的差异,单因素和多因素回归分别分析初治DLBCL患者临床病理特征与预后的关系。结果:治疗前血浆Fib高水平组DLBCL患者中,血清乳酸脱氢酶(LDH)水平高于正常上限、Ann Arbor分期Ⅲ~Ⅳ、B症状、更高的国际预后指数(IPI)和NCCN-IPI评分的患者比例显著高于Fib低水平组。LDH水平高于正常、ECOG评分2~4分、Ann Arbor分期Ⅲ~Ⅳ、结外侵犯部位>1处、Fib高水平的初治DLBCL患者的OS、PFS较其他患者更短。多因素分析显示,LDH水平高于正常、ECOG评分2~4分是初治DLBCL患者OS的独立不良预后因子,LDH水平高于正常、结外侵犯部位>1处是初治DLBCL患者PFS的独立不良预后因子,治疗前血浆Fib高水平不是初治DLBCL患者OS、PFS的独立不良预后因子。结论:治疗前血浆Fib高水平与初治DLBCL患者不良预后相关,但并不是独立不良预后因子。Objective:To explore the prognostic value of plasma fibrinogen(Fib)level before treatment in patients with newly diagnosed diffuse large B-cell lymphoma(DLBCL).Methods:The association of plasma Fib level before treatment and clinicopathological characteristics and prognosis of 389 patients with newly diagnosed DLBCL who met inclusion criteria was analyzed retrospectively.The cut-off value of plasma Fib level before treatment was determined by a receiver operator characteristic curve.Patients were divided into high level group(245 cases)and low level group(144 cases)according to the cut-off value.The differences in clinicopathological characteristics,overall survival(OS)and disease progression-free survival(PFS)between the two groups were compared.The relationship of clinicopathological characteristics and prognosis in patients with newly diagnosed DLBCL was analyzed by univariate and multivariate regression analysis.Results:The proportion of patients with serum lactate dehydrogenase(LDH)>upper limit of normal,Ann Arbor stageⅢ-Ⅳ,B symptoms,higher international prognostic index(IPI)score and NCCN-IPI score was significantly higher in high plasma Fib group than those in low level group.Newly diagnosed DLBCL patients with LDH>upper limit of normal,or ECOG score 2-4,or Ann Arbor stageⅢ-Ⅳ,or more than 1 site of extranodal diseases,or high plasma Fib level had shorter OS and PFS than others.Multivariate analysis showed that LDH>upper limit of normal and ECOG score 2-4 were independent poor prognostic factors for OS of patients with newly diagnosed DLBCL.LDH>upper limit of normal and more than 1 site of extranodal diseases were independent poor prognostic factors for PFS of patients with newly diagnosed DLBCL.High plasma Fib level before treatment was not an independent poor prognostic factor for OS and PFS of patients with newly diagnosed DLBCL.Conclusion:High plasma Fib level before treatment is associated with poor prognosis for patients with newly diagnosed DLBCL,but not an independent poor prognostic factor.

关 键 词：弥漫大B细胞淋巴瘤 纤维蛋白原 预后 

分 类 号：R733.4[医药卫生—肿瘤]