初诊弥漫大B细胞淋巴瘤患者外周血B细胞计数与临床特征及预后的相关性分析  

Correlation Analysis of Peripheral Blood B Cell Count with Clinical Features and Prognosis in Patients Newly Diagnosed with Diffuse Large B-Cell Lymphoma

作　　者：陆天 米浩 赵丹丹 杨水个 步云文[2] 张芳[2] 陈文明[3] 孙道萍[2] LU Tian;MI Hao;ZHAO Dan-Dan;YANG Shui-Ge;BU Yun-Wen;ZHANG Fang;CHEN Wen-Ming;SUN Dao-Ping(College of Clinical Medicine,Jining Medical University,Jining 272013,Shandong Province,China;Department of Hematology,Jining No.1 People′s Hospital,Jining 272011,Shandong Province,China;Department of Oncology,Jining No.1 People′s Hospital,Jining 272011,Shandong Province,China)

机构地区：[1]济宁医学院临床医学院,山东济宁272013 [2]济宁市第一人民医院血液内科,山东济宁272011 [3]济宁市第一人民医院肿瘤科,山东济宁272011

出　　处：《中国实验血液学杂志》2024年第2期458-465,共8页Journal of Experimental Hematology

基　　金：山东省自然科学基金(ZR2020MH207,ZR2020MH251)。

摘　　要：目的:探讨外周血B细胞计数与初诊弥漫性大B细胞淋巴瘤(DLBCL)患者临床特征及预后的相关性。方法:回顾性分析67例初诊DLBCL患者治疗前外周血B细胞计数与其临床特征、实验室指标、治疗疗效及预后的关系。结果:按照B细胞计数中位值将患者分为低B细胞计数组(B细胞<0.1×10^(9)/L,n=34)和高B细胞计数组(B细胞≥0.1×10^(9)/L,n=33)。与高B细胞计数组相比,低B细胞计数组中有更高比例的Lugano分期III-IV期、LDH升高、β2-MG升高及IPI评分3-5的患者(P值分别为0.033、0.000、0.023、0.001),且CRP升高更多见(P=0.033)。低B细胞计数组的外周血CD3^(+)和CD4^(+)细胞计数显著低于高B细胞计数组(P=0.010,0.017)。高B细胞计数组患者初始治疗后总缓解率(ORR)及完全缓解(CR)率均显著高于低B细胞计数组(P=0.032,0.013)。中位随访时间为23(2-77)个月,高B细胞计数组患者的无进展生存(PFS)率及总生存(OS)率均明显优于低B细胞计数组(P=0.001,P=0.002)。单因素分析显示,初诊外周血低B细胞计数与PFS和OS缩短相关(HR=4.108,P=0.002;HR=8.218,P=0.006)。多因素分析显示,低B细胞计数是导致PFS缩短(HR=3.116,P=0.037)的独立预后因素。结论:初诊DLBCL患者外周血B细胞计数降低与高危临床特征相关,并可能影响免疫化疗的疗效,与较差的临床预后有关。Objective:To explore the correlation between peripheral blood B cell count and clinical features and prognosis of patients with newly diagnosed diffuse large B-cell lymphoma(DLBCL).Methods:The relationship of peripheral blood B cell count with clinical features,laboratory indexes and prognosis in 67 patients with newly diagnosed DLBCL was retrospectively analyzed.Results:Patients were divided into low B-cell count group(B cell<0.1×10^(9)/L,n=34)and high B-cell count group(B cell≥0.1×10^(9)/L,n=33)according to the median B cell count values.Compared with the high B cell count group,the low B cell count group had a higher proportion of patients with Lugano stage III-IV,elevated LDH,elevatedβ2-MG and IPI score 3-5 and increased CRP(P=0.033,0.000,0.023,0.001,0.033).The peripheral CD3^(+)and CD4^(+)cell counts of patients in the low B cell count group were significantly lower than those in the high B cell count group(P=0.010,0.017).After initial treatment,overall response rate(ORR)and complete remission(CR)rate in high B cell count group were significantly higher than those in low B cell count group(P=0.032,0.013).The median follow-up time of patients was 23(2-77)months,progression-free survival(PFS)and overall survival(OS)of patients in the high B cell count group were significantly better than those in the low B cell count group(P=0.001,0.002).Univariate analysis showed that pretreatment low B cell count in the peripheral blood was associated with shortened PFS and OS(HR=4.108,P=0.002;HR=8.218,P=0.006).Multivariate analysis showed that low B cell count was an independent prognostic factor for shortened PFS(HR=3.116,P=0.037).Conclusion:Decreased peripheral blood B cell count in newly diagnosed DLBCL patients is associated with high-risk clinical features and may affect the efficacy of immunochemotherapy,which is associated with poor clinical prognosis.

关 键 词：弥漫大B细胞淋巴瘤 B细胞 外周血 预后 

分 类 号：R733.1[医药卫生—肿瘤]