利妥昔单抗治疗弥漫大B细胞淋巴瘤患者的效果及其耐药的多因素分析  

Multivariate Analysis of the Resistance and Efficacy of Rituximab in the Treatment of Diffuse Large B-cell Lymphoma Patients

作　　者：娄小飞[1] 杜可朴[2] LOU Xiaofei;DU Kepu(Department of Pharmacy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院药学部,河南郑州450052 [2]郑州大学第一附属医院放射科,河南郑州450052

出　　处：《河南医学研究》2023年第16期3019-3022,共4页Henan Medical Research

基　　金：2021年度河南省青年人才托举工程项目(2021HYTP058)。

摘　　要：目的探讨利妥昔单抗治疗弥漫大B细胞淋巴瘤(DLBCL)有效性,并分析患者耐药的影响因素。方法选取2018年7月至2022年10月郑州大学第一附属医院收治的147例DLBCL患者,均接受利妥昔单抗治疗,计算客观缓解率(ORR)及耐药率,通过单因素及多因素logistic回归方程分析利妥昔单抗耐药的影响因素。结果147例DLBCL患者中,有70例完全缓解(CR)47.62%,15例不确定部分缓解(CRu)10.20%,20例部分缓解(PR)13.61%,42例复发或进展(SD或PD)28.57%,ORR为71.43%。化疗后6个月内病死14例,难治/复发37例,耐药率为34.69%。耐药组B症状患者比例高于对照组,血红蛋白(Hb)、白蛋白(ALB)、淋巴细胞与细胞计数比值(LMR)、钙离子通道A1C(CACNA1C)低于对照组,β_(2)-微球蛋白(β_(2)-MG)、红细胞沉降率(ESR)、乳酸脱氢酶(LDH)、中性粒细胞与淋巴细胞计数比值(NLR)、白细胞介素-17A(IL-17A)高于对照组(P<0.05)。B症状(OR=5.809)、ALB(OR=0.454)、NLR(OR=5.724)、LMR(OR=0.344)、CACNA1C(OR=0.467)、IL-17A(OR=9.143)是利妥昔单抗耐药的独立影响因素(P<0.05)。结论利妥昔单抗治疗DLBCL效果显著,但仍有34.69%患者因利妥昔单抗耐药难治/复发/病死。B症状、ALB、NLR、LMR、CACNA1C、IL-17A是导致利妥昔单抗耐药的独立危险因素,临床工作中需根据相关因素制定针对性预防措施,加强管理,以降低利妥昔单抗耐药风险,改善预后。Objective To investigate the efficacy of rituximab in the treatment of diffuse large B-cell lymphoma(DLBCL)and analyze the influencing factors of drug resistance in patients.Methods A total of 147 DLBCL patients admitted to First Affiliated Hospital of Zhengzhou University from July 2018 to October 2022 were selected,all of whom received rituximab treatment.Objective response rate(ORR)and drug resistance rate were calculated,and the influencing factors of rituximab resistance were analyzed through single factor and multivariate logistic regression equations.Results Of the 147 DLBCL patients,70 cases had complete response(CR)47.62%,15 cases had uncertain partial response(CRu)10.20%,20 cases had partial response(PR)13.61%,42 cases had relapse or progression(SD or PD)28.57%,and ORR was 71.43%.Within 6 months after chemotherapy,14 cases died,37 cases were refractory/relapsed,and the drug resistance rate was 34.69%.The proportion of symptom B patients in drug-resistant group was higher than that in control group,while hemoglobin(Hb),albumin(ALB),lymphocyte to cell count ratio(LMR)and calcium channel A1C(CACNA1C)were lower than those in control group.β_(2)-microglobulin(β_(2)-MG),erythrocyte sedimentation rate(ESR),lactate dehydrogenase(LDH),neutrophil to lymphocyte count ratio(NLR)and interleukin-17A(IL-17A)were higher than those in control group(P<0.05).B symptoms(OR=5.809),ALB(OR=0.454),NLR(OR=5.724),LMR(OR=0.344),CACNA1C(OR=0.467),IL-17A(OR=9.143)were independent influencing factors for rituximab resistance(P<0.05).Conclusion Rituximab is effective in the treatment of DLBCL,but 34.69%of patients still died due to rituximab resistance.B Symptoms,ALB,NLR,LMR,CACNA1C and IL-17A are independent risk factors leading to rituximab resistance.In clinical work,targeted prevention measures should be developed according to related factors and management should be strengthened to reduce the risk of rituximab resistance and improve the prognosis.

关 键 词：弥漫大B细胞淋巴瘤 利妥昔单抗 耐药现象 影响因素 

分 类 号：R733[医药卫生—肿瘤]