Liu Wei, Zhagn Guo-Xiang, Shi Wen-Zhi, Dong Lu, Liu Hua, Shen Xu-Liang
Department of Hematology, Peace Hospital Affiliated to Changzhi Medical College, Changzhi 046000,Shanxi Province,China.
Department of Hematology, Peace Hospital Affiliated to Changzhi Medical College, Changzhi 046000,Shanxi Province,China. E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2017 Apr;25(2):449-454. doi: 10.7534/j.issn.1009-2137.2017.02.025.
To investigate the changes of CD4 T lymphocytes in peripheral blood of patients with follicular lymphoma and its clinical significance.
Blood samples were collected for detection of whole blood cells, including absolute monocyte count (AMC), absolute lymphocyte count (ALC), hemoglobin (Hb), platelet count (Plt). Age, sex, pathological grade, number of involved lymph nodes, bone marrow involvement (BMI), Ann Arbor stage, B symptoms, serum lactate dehydrogenase (LDH) and serum β-2 microglobulin (β2-MG) were recorded, the prognostic stratification was performed by using FLIPI and FLIPI-2. The T lymphocyte subsets were analyzed by flow cytometry, including the absolute number of CD4 T lymphocytes (ACD4C) and the absolute number of CD8 T lymphocytes (ACD8C).
Patients were with higher Ann Arbor stage, Hb<120 g/L, LDH greater than the upper limit of normal, the number of lymph nodes were involved> 4, the bone marrow was involvement, β2-MG levels were high FLIPI score and FLIPI-2 score, AMC level was higher (P<0.05). There were no significant differences in ACD4C levels among different groups. Patients with AMC≥0.89×10/L showed a shorter progression-free survival (PFS) and a shorter overall survival time (OS) (P=0.010,0.002) as compared with patients with AMC<0.89×10/L. The patients with ACD4C>0.16×10/L had longer progression-free survival and overall survival time, as compared with patients with ACD4C ≤0.16×10/L (P=0.016,0.012). Low ACD4C and high AMC related with shorter PFS and OS (P=0.013, 0.020). Univariate Cox regression analysis showed that age (P=0.026), bone marrow involvement (P=0.017), elevated LDH (P=0.001), β2-MG (P=0.014), FLIPI and FLIP2 score (P= 0.004 and 0.000) related with a shorter PFS. Multivariable Cox regression analysis showed that Hb (P=0.015), elevated LDH (P=0.003), β2-MG (P=0.045), bone marrow involvement (P=0.016) and FLIPI-2 score(P=0.003) related with short OS. ACD4C ≤0.16×10/L was a factor influencing prognosis of FL patients (PFS and OS) (P<0.05).
Low ACD4C levels relatees with poor prognosis of patients with FL, and the ACD4C levels may be an important predictor for FL disease and prognosis.
探讨滤泡性淋巴瘤患者外周血CD4 T淋巴细胞变化及其临床意义。
采集血液样本检测全血细胞，包括绝对单核细胞计数（AMC）、绝对淋巴细胞计数（ALC）、血红蛋白（Hb）、血小板计数（Plt）。记录年龄、性别、病理分级、受累淋巴结数目、骨髓受累情况（BMI）、Ann Arbor分期、B症状、血清乳酸脱氢酶（LDH）及血清β2微球蛋白（β2-MG），采用滤泡性淋巴瘤国际预后指数（FLIPI）和FLIPI-2进行预后分层。采用流式细胞术分析T淋巴细胞亚群，包括CD4 T淋巴细胞绝对数（ACD4C）和CD8 T淋巴细胞绝对数（ACD8C）。
患者Ann Arbor分期较高、Hb < 120 g/L、LDH高于正常上限、受累淋巴结数目>4个、骨髓受累、β2-MG水平高、FLIPI评分及FLIPI-2评分高、AMC水平较高（P < 0.05）。不同组间ACD4C水平差异无统计学意义。与AMC < 0.89×10⁹/L的患者相比，AMC≥0.89×10⁹/L的患者无进展生存期（PFS）较短，总生存时间（OS）较短（P = 0.010，0.002）。与ACD4C≤0.16×10⁹/L的患者相比，ACD4C>0.16×10⁹/L的患者PFS和OS较长（P = 0.016，0.012）。低ACD4C和高AMC与较短的PFS和OS相关（P = 0.013，0.020）。单因素Cox回归分析显示，年龄（P = 0.026）、骨髓受累（P = 0.017）、LDH升高（P = 0.00¹）、β2-MG（P = 0.014）、FLIPI和FLIP2评分（P = 0.004和0.000）与较短的PFS相关。多因素Cox回归分析显示，Hb（P = 0.015）、LDH升高（P = 0.003）、β2-MG（P = 0.045）、骨髓受累（P = 0.016）及FLIPI-2评分（P = 0.003）与较短的OS相关。ACD4C≤0.16×10⁹/L是影响滤泡性淋巴瘤患者预后（PFS和OS）的因素（P < 0.05）。
低ACD4C水平与滤泡性淋巴瘤患者预后不良相关，ACD4C水平可能是滤泡性淋巴瘤病情及预后的重要预测指标。
