血清游离轻链和硒水平与B细胞非霍奇金淋巴瘤患者临床病理特征的关系及预后风险模型的构建  

Relationship between serum free light chain and selenium levels and clinicopathological characteristics of B-cell non-Hodgkin lymphoma patients and construction of prognostic risk model

作　　者：涂佳强 文晓玲 TU Jiaqiang;WEN Xiaoling(Department of Hematology,Yibin First People's Hospital,Yibin 644000,Sichuan,China)

机构地区：[1]宜宾市第一人民医院血液科,四川宜宾644000

出　　处：《检验医学》2024年第7期687-695,共9页Laboratory Medicine

摘　　要：目的探讨血清游离轻链(FLC)和硒水平与B细胞非霍奇金淋巴瘤(B-NHL)患者临床病理特征的关系,并构建预后风险模型。方法选取2014年6月—2021年6月宜宾市第一人民医院B-NHL患者164例,作为训练集;另选取82例B-NHL患者作为验证集。收集所有患者的临床资料,并检测血清FLC、硒水平和血常规。对所有患者进行8~108个月随访,随访截止时间为2023年6月。采用Kaplan-Meier生存曲线评估不同血清FLC、硒水平患者的生存情况。采用Cox比例风险回归分析评估影响B-NHL患者无进展生存率和总生存率的因素。采用R软件构建预测B-NHL患者预后的列线图风险预测模型并评价其效能。结果根据B-NHL患者FLC水平是否升高分为低FLC水平(87例)和高FLC水平(77例),低FLC水平与高FLC水平的B-NHL患者之间Ann Arbor分期和B症状差异有统计学意义(P<0.05)。根据血清硒水平的中位数(1.12μmol/L)将所有患者分为低硒水平(82例)和高硒水平(82例),低硒水平与高硒水平的B-NHL患者之间美国东部肿瘤协作组(ECOG)评分差异有统计学意义(P<0.05)。高FLC水平患者和低硒水平患者的无进展生存率、总生存率分别低于低FLC水平患者和高硒水平患者(P<0.01)。多因素Cox比例风险回归分析结果显示,年龄>60岁、国际预后指数(IPI)为3~5分、乳酸脱氢酶(LDH)>250 U·L^(-1)、β2-微球蛋白(β2-MG)>3 mg·L^(-1)、血清硒水平降低是B-NHL患者无进展生存率和总生存率降低的危险因素(P<0.05),血清FLC升高是B-NHL患者无进展生存率降低的危险因素(P<0.01)。预测模型判断B-NHL患者预后不良的曲线下面积为0.856,在训练集和验证集中的准确性、敏感性、特异性相近,稳定性较好(Nagelkerke R2=0.602)。结论高FLC水平与B-NHL患者的Ann Arbor分期和B症状有关,低硒水平与B-NHL患者的ECOG评分有关。基于临床病理特征构建的列线图风险预测模型能较准确地评估B-NHL患者的预后情况。Objective To investigate the relationship between serum free light chain(FLC)and selenium levels in clinicopathological characteristics of B-cell non-Hodgkin lymphoma(B-NHL)patients,and to construct a prognostic risk model.Methods A total of 164 B-NHL patients from Yibin First People's Hospital from June 2014 to June 2021 were enrolled as training set.Another 82 patients with B-NHL were enrolled as validation set.The clinicopathological characteristics of all the patients were collected,and serum FLC and selenium levels and blood routine test were determined and performed.All the patients were followed up for 8 to 108 months until June 2023.Kaplan-Meier survival curve was used to evaluate the survival of patients with different serum FLC and selenium levels.The factors on progress-free survival and overall survival in B-NHL patients were evaluated by Cox proportional hazard regression analysis.R software was used to construct a nomogram risk model for predicting the prognosis of B-NHL patients and evaluating its efficacy.Results B-NHL patients were classified into low FLC level(87 cases)and high FLC level(77 cases)according to whether the FLC level was increased.There was statistical significance in Ann Arbor stage and B symptoms between B-NHL patients with low FLC level and high FLC level(P<0.05).According to the median of serum selenium level(1.12μmol/L),all the patients were classified into low selenium level(82 cases)and high selenium level(82 cases),and there was statistical significance in the Eastern Cooperative Oncology Group(ECOG)score between low selenium level and high selenium level B-NHL patients(P<0.05).The progress-free survival and overall survival of patients with high FLC level and low selenium level were lower than those with low FLC level and high selenium level,respectively(P<0.01).Multivariate Cox proportional risk regression analysis showed that age>60 years old,international prognostic index(IPI)score of 3-5,lactate dehydrogense(LDH)>250 U·L^(-1),beta2-microglobulin(β2-MG)>3 mg·L^(-1)a

关 键 词：游离轻链 硒 B细胞非霍奇金淋巴瘤 病理特征 预后 

分 类 号：R446.1[医药卫生—诊断学]