乳酸脱氢酶在弥漫性大B细胞淋巴瘤患者随访中的作用
The utility of lactate dehydrogenase in the follow up of patients with diffuse large B-cell lymphoma.
作者信息
William Basem Magdy, Bongu Navneeth Rao, Bast Martin, Bociek Robert Gregory, Bierman Philip Jay, Vose Julie Marie, Armitage James Olen
机构信息
University Hospitals Case Medical Center / Case Western Reserve University, Cleveland, OH, USA.
出版信息
Rev Bras Hematol Hemoter. 2013;35(3):189-91. doi: 10.5581/1516-8484.20130055.
BACKGROUND
Serum lactate dehydrogenase is a non-specific marker for lymphoma whose prognostic significance is well established for both indolent and aggressive lymphomas at the time of diagnosis. The performance characteristics of this enzyme in predicting relapse in patients with diffuse large B-cell lymphoma has not been well studied.
METHODS
This study compared serum lactate dehydrogenase levels in 27 patients with diffuse large B-cell lymphoma who relapsed after sustaining a complete response versus 87 patients who did not relapse. For relapsed patients, the serum lactate dehydrogenase level at relapse was compared with the level three months before (considered baseline). For non-relapsed patients, the last two levels during follow-up were compared. For statistical analysis the T-test was used to compare differences in mean values between groups. The sensitivity, specificity, positive and negative predictive values for serum lactate dehydrogenase in detecting relapse compared to confirmatory imaging were calculated.
RESULTS
At relapse, only 33% patients had increases in serum lactate dehydrogenase above the upper limit of normal. The mean increase was 1.2-fold above the upper limit of normal for relapsed vs. 0.83 for those who did not relapse (p-value = 0.59). The mean increase in serum lactate dehydrogenase, from baseline, was 1.1-fold in non-relapsed vs. 1.3 in relapsed patients (p-value = 0.3). The likelihood ratio of relapse was 4.65 for patients who had 1.5-fold increases in serum lactate dehydrogenase above baseline (p-value = 0.03). The sensitivity, specificity, positive and negative predictive values of 1.5-fold increases for detecting relapse, compared to clinical and imaging findings were 0.18, 0.95, 0.55, and 0.79, respectively.
CONCLUSION
A 1.5-fold increase in serum lactate dehydrogenase, over a period of 3 months, is associated with increased likelihood of relapse from diffuse large B-cell lymphoma.
背景
血清乳酸脱氢酶是淋巴瘤的一种非特异性标志物，其预后意义在惰性淋巴瘤和侵袭性淋巴瘤诊断时已得到充分证实。该酶在预测弥漫性大B细胞淋巴瘤患者复发方面的性能特征尚未得到充分研究。
方法
本研究比较了27例弥漫性大B细胞淋巴瘤患者在获得完全缓解后复发与87例未复发患者的血清乳酸脱氢酶水平。对于复发患者，将复发时的血清乳酸脱氢酶水平与三个月前的水平（视为基线）进行比较。对于未复发患者，比较随访期间的最后两个水平。采用T检验进行统计学分析，比较组间平均值的差异。计算血清乳酸脱氢酶检测复发与确认性影像学检查相比的敏感性、特异性、阳性和阴性预测值。
结果
复发时，只有33%的患者血清乳酸脱氢酶升高超过正常上限。复发患者的平均升高幅度比正常上限高1.2倍，而未复发患者为0.83倍（p值 = 0.59）。血清乳酸脱氢酶从基线开始的平均升高幅度，未复发患者为1.1倍，复发患者为1.3倍（p值 = 0.3）。血清乳酸脱氢酶比基线升高1.5倍的患者复发的似然比为4.65（p值 = 0.03）。与临床和影像学检查结果相比，血清乳酸脱氢酶升高1.5倍检测复发的敏感性、特异性、阳性和阴性预测值分别为0.18、0.95、0.55和0.79。
结论
在3个月内血清乳酸脱氢酶升高1.5倍与弥漫性大B细胞淋巴瘤复发可能性增加相关。
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