首页|HBV感染的B细胞型非霍奇金淋巴瘤病人临床特征及预后分析

HBV感染的B细胞型非霍奇金淋巴瘤病人临床特征及预后分析

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目的 探讨乙型肝炎病毒(HBV)感染与B细胞型非霍奇金淋巴瘤(B-NHL)的关系,分析其临床特征及预后.方法 收集345例初发B-NHL病人的临床资料,分为乙肝表面抗原(HBsAg)阳性组和HBsAg阴性组,比较B-NHL病人与全国一般人群HBV感染率的差异,并对两组病人的临床特征、预后进行分析.结果 345例B-NHL病人HBsAg阳性率为18.8%,明显高于全国一般人群的7.2%,二项式检验显示差异有统计学意义(P<0.001).与HBsAg阴性组中位发病年龄(58岁)相比,HBsAg阳性组(48岁)明显偏小(t=5.675,P<0.01)、更易累及肝、脾或腹膜后淋巴结(x 2=6.216~10.137,P<0.05)、疾病分期晚(Ⅲ/Ⅳ期)(x2=9.771,P<0.05)、且预后较差(x2=4.748~8.300,P<0.05).单因素分析显示,HBsAg阳性组病人预后的不良因素包括:B症状、AnnArbor分期(Ⅲ/Ⅳ期)、β2微球蛋白升高、未联合利妥昔单抗、未联合放疗(x 2=3.860~26.767,P<0.05).多因素分析显示,B症状、Ann Arbor分期(Ⅲ/Ⅳ期)、未联合利妥昔单抗仍与预后差有关(95%CI=0.170~31.746,P<0.05).结论 B-NHL病人HBV感染率明显高于普通人群,HBV相关B-NHL具有其独特的临床表现,并且预后相对较差,利妥昔单抗的应用可改善HBsAg阳性病人预后.
CLINICAL FEATURES AND PROGNOSTIC ANALYSIS OF PATIENTS WITH B-CELL NON-HODGKIN'S LYMPHOMA AND HEPATITIS B VIRUS INFECTION
Objective To investigate the relationship between hepatitis B virus (HBV) infection and B-cell non-Hodgkin's lymphoma (B-NHL),and to analyze the clinical features and prognosis of B-NHL patients with HBV infection.Methods A total of 345 B-NHL patients were divided into hepatitis B surface antigen (HBsAg)-positive group (n =65) and HBsAg-negative group (n =280).The clinical features and prognosis of the patients in the two groups were analyzed and the HBsAg-positive rate was compared between the 345 B-NHL patients and the general population in China.Results The HBsAg-positiverate in the 345 B-NHL patients was significantly higher than that in the general population in China (18.8% vs 7.2%,P<0.001,binomial test).Compared with the HBsAg-negative group,the HBsAg-positive group had a significantly younger median age of onset (t=5.675,P<0.01),significantly higher incidence of involvement of the liver,spleen,or retroperitoneal lymph node (x2 =6.216-10.137,P<0.05),a significantly later stage of disease (Ⅲ/Ⅳ) (x2 =9.771,P<0.05),and a significantly worse prognosis (x 2 =4.748-8.300,P <0.05).Univariate analysis showed that the poor prognostic factors for the patients in the HBsAg-positive group were B symptoms,Ann Arbor staging (Ⅲ/Ⅳ),increased β2-microglobulin level,not combined with rituximab,and not combined with radiotherapyd (x2 =3.860-26.767,P<0.05).Multivariate analysis showed that the poor prognosis was associated with B symptoms,Ann Arbor staging (Ⅲ/Ⅳ),and not combined with rituximab (95%CI=0.170-31.746,P<0.05).Conclusion The HBV infection rate in B-NHL patients is significantly higher than that in the general population in China.B-NHL patients with HBV infection have unique clinical manifestations and relatively poor prognosis and rituximab can improve the prognosis of B-NHL patients with HBV infection.

B-cell non-Hodgkin lymphomahepatitis B virusprognosis

李晓利、张希远、史春雷、王玲

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青岛大学第二临床医院(青岛市中心医院)血液科,山东青岛266042

B细胞型非霍奇金淋巴瘤 乙型肝炎病毒 预后

青岛市卫生和计划生育委员会立项课题

WJZD-045

2017

齐鲁医学杂志
青岛大学医学院

齐鲁医学杂志

影响因子:0.609
ISSN:1008-0341
年,卷(期):2017.32(3)
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