摘要
目的探究血清β_(2)-微球蛋白(β_(2)-MG)联合乳酸脱氢酶(LDH)在弥漫性大B细胞淋巴瘤(DLBCL)患者中的预后价值。方法选择2011年1月—2018年12月山东省滨州市人民医院血液科收治DLBCL患者82例作为DLBCL组,并根据随访3年生存情况分为生存亚组46例和死亡亚组36例,另选同期于医院治疗的淋巴结反应增生(RLNH)患者43例作为RLNH组。比较2组患者血清β_(2)-MG、LDH水平;Pearson检验分析DLBCL患者血清β_(2)-MG与LDH的相关性;比较血清β_(2)-MG、LDH水平在DLBCL患者不同临床病理特征中的差异;Kaplan-Meier法绘制生存曲线分析血清β_(2)-MG、LDH水平及二者联合与DLBCL患者预后的关系;多因素Logistic回归分析影响DLBCL患者预后的危险因素;受试者工作特征曲线(ROC)分析血清β_(2)-MG、LDH及二者联合对DLBCL患者预后的预测价值。结果DLBCL组血清β_(2)-MG、LDH水平明显高于RLNH组(t/P=6.941/<0.001、6.980/<0.001),DLBCL患者血清β_(2)-MG与LDH呈明显正相关(r/P=0.553/<0.001);DLBCL患者血清β_(2)-MG、LDH水平分别与临床分期、国际预后指数(IPI)评分、美国东部协作肿瘤组体质状态(ECOG PS)评分有关,而LDH还与病理类型有关(P均<0.05);血清β_(2)-MG高表达患者3年生存率明显低于低表达患者(43.90%vs.68.29%,χ^(2)/P=4.952/0.026),血清LDH高表达患者3年生存率明显低于低表达患者(39.02%vs.73.17%,χ^(2)/P=9.705/0.002);死亡亚组临床分期Ⅲ~Ⅳ期、有B症状、IPI评分3~4分、ECOG PS评分>2分、淋巴细胞计数降低、β_(2)-MG高表达、LDH高表达比例明显高于生存亚组(P<0.05)。临床分期Ⅲ~Ⅳ期、有B症状、IPI评分3~4分、β_(2)-MG高表达、LDH高表达是导致DLBCL患者预后不良的独立危险因素[OR(95%CI)=3.864(3.436~4.402)、3.587(3.124~4.086)、4.247(3.724~4.943)、4.165(3.763~4.716)、4.032(3.521~4.482)];血清β_(2)-MG、LDH及二者联合预测DLBCL的ROC曲线下面积分别为0.642、0.775和0.852,二者联合的AUC高于单独预测价值(Z/P=9.421/<0.001、8.246/<0.001)。结论DLBCL患者血清β_(2)-MG、LDH高表达,二者联合在DLBCL患者预后中具有一定的预测价值。
Objective To explore the prognostic value of serumβ_(2)-microglobulin(β_(2)-MG)combined with lactate dehydrogenase(LDH)in patients with diffuse large B-cell lymphoma(DLBCL).Methods A total of 82 DLBCL patients admitted to the Department of Hematology,Binzhou People's Hospital,Shandong Province from January 2011 to December 2018 were selected as the DLBCL group,and were divided into a survival subgroup of 46 cases and a death subgroup of 36 cases according to the 3-year follow-up survival.Forty-three patients with reactive lymph node hyperplasia(RLNH)treated in the hospital during the same period were selected as the RLNH group.The serum levels ofβ_(2)-MG and LDH were compared between the two groups.The Pearson test was used to analyze the correlation between serumβ_(2)-MG and LDH in DLBCL patients;the differences of serumβ_(2)-MG and LDH levels in different clinicopathological characteristics of DLBCL patients were compared.The survival curve was drawn by Kaplan Meier method to analyze the relationship between serumβ_(2)-MG and LDH levels and their combination with the prognosis of DLBCL patients.Multivariate Logistic regression analysis of risk factors affecting the prognosis of patients with DLBCL.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serumβ_(2)-MG,LDH and their combination on the prognosis of DLBCL patients.Results The levels of serumβ_(2)-MG and LDH in DLBCL group were significantly higher than those in RLNH group(t/P=6.941/<0.001,6.980/<0.001),and serumβ_(2)-MG in DLBCL patients was significantly positively correlated with LDH(r/P=0.553/<0.001).Serumβ_(2)-MG and LDH levels in DLBCL patients were related to clinical stage,International Prognostic Index(IPI)score,and Eastern Cooperative Oncology Group Physical Status(ECOG PS)score,respectively,while LDH was also related to pathological type(all P<0.05).The 3-year survival rate of patients with high serumβ_(2)-MG expression was significantly lower than that of patients with low expression(43.90%vs.68.29%,χ^(2)/P=4.952/0.026),and the 3-year survival rate of patients with high serum LDH expression was significantly lower than that of patients with low serum LDH expression(39.02%vs.73.17%,χ^(2)/P=9.705/0.002).The death subgroup had a significantly higher proportion of clinical stage III-IV,B symptoms,IPI score 3-4,ECOG PS score>2,decreased lymphocyte count,high expression ofβ_(2)-MG,and high LDH expression than the survival subgroup(P<0.05).Clinical stage III to IV,B symptoms,IPI score of 3 to 4,high expression ofβ_(2)-MG,and high expression of LDH were independent risk factors for poor prognosis in patients with DLBCL[OR(95%CI)=3.864(3.436-4.402),3.587(3.124-4.086),4.247(3.724-4.943),4.165(3.763-4.716),4.032(3.521-4.482)].The areas under the ROC curve of serumβ_(2)-MG,LDH and the combination of the two were 0.642,0.775 and 0.852,respectively,and the AUC of the combination was higher than the predictive value alone(Z/P=9.421/<0.001,8.246/<0.001).Conclusion Serumβ_(2)-MG and LDH are highly expressed in DLBCL patients,and their combination has a certain predictive value in the prognosis of DLBCL patients.
作者
郑永青
孙明东
王瑞芳
王立盼
李砚如
Zheng Yongqing;Sun Mingdong;Wang Ruifang;Wang Lipan;LiYanru(Department of Hematology, Binzhou People's Hospital, Shandong Province,Binzhou 256600, China)
出处
《疑难病杂志》
CAS
2022年第6期582-587,共6页
Chinese Journal of Difficult and Complicated Cases
基金
山东省医药卫生科技发展计划项目(2018WS578)。
