Zhang L, Yuan X L, Jiang L, Yang J, Guo J M, Shi J, Lei P C, Zhang Y, Zhu Z M
Institute of Hematology of Henan People's Hospital, Zhengzhou 450003, China.
Zhonghua Xue Ye Xue Za Zhi. 2018 Jul 14;39(7):563-568. doi: 10.3760/cma.j.issn.0253-2727.2018.07.007.
To explore the clinical characteristics and prognostic factors of the patients with non-Hodgkin's Lymphoma (NHL) complicated with HBV infection, so as to provide a basis for clinical accurate diagnosis and prognosis evaluation. The data of 313 newly diagnosed NHL patients from August 2012 to July 2016 were collected. The HBV serological markers were detected by ELISA, and HBV DNA was quantified by full automatic microparticle chemiluminescence immunoassay (≥1×10(5) copies/ml as high copy group, 1×10(3)-<1×10(5) copies/ml as low copy group). The relationship between HBV infection and prognosis was analyzed combined with the clinical features of the patients, and the HBV detection rate was compared with that of the common population (from the national HBV sero epidemiological data). ①The positive rate of HBsAg in NHL patients was 12.5% (39/313), which was higher than 7.2% in the general population ((2)=14.596, <0.001). HBV infection in the past (HBsAg negative but HBcAb positive) in 114 cases (36.4%), the incidence was slightly higher than that in the general population (34.1%). ②Compared HBsAg positive group with the negative group, the proportion of B cell type (87.2% 70.3%, =0.027), Ann Arbor stage Ⅲ-Ⅳ(69.2% 34.6%, <0.001), IPI score 3-5 (74.4% 50%, =0.004), LDH level (79.5% 47.8%, <0.001) and liver involvement (45.5% 31.7%, =0.006) were all higher. The difference was statistically significant. ③Compared the HBV infected group (114 cases) with the non-infected group (160 cases), the difference had statistical significance in the proportion of Ann Arbor stage Ⅲ-Ⅳ (=0.023) and IPI score 3-5 scores =0.035). ④Compared HBV DNA positive group (30 cases) with negative group (71 cases), Ann Arbor stage Ⅲ-Ⅳ (=0.011), IPI score 3-5 score (=0.030), LDH level (=0.025) and liver involvement (<0.001) in the proportion of patients had statistical significance. The positive patients were divided into HBV DNA high and low copy groups with 1×10(5) copies of /ml as the boundary. The results showed that there was no statistical difference between the two groups (>0.05). The HBV infection rate of NHL patients is significantly higher than that of the general population, and HBV infection is more closely related to B cell type NHL. Patients with HBV infection and HBV DNA positive had late Ann Arbor stage, high IPI score, high LDH level and liver involvement, and the prognosis is poor.
探讨非霍奇金淋巴瘤（NHL）合并HBV感染患者的临床特征及预后因素，为临床准确诊断及预后评估提供依据。收集2012年8月至2016年7月新诊断的313例NHL患者资料。采用ELISA法检测HBV血清学标志物，全自动微粒子化学发光免疫分析法对HBV DNA进行定量（≥1×10⁵拷贝/ml为高拷贝组，1×10³ - ＜1×10⁵拷贝/ml为低拷贝组）。结合患者临床特征分析HBV感染与预后的关系，并与普通人群（来源于全国HBV血清流行病学数据）的HBV检出率进行比较。①NHL患者HBsAg阳性率为12.5%（39/313），高于普通人群的7.2%（χ² = 14.596，P ＜0.001）。既往有HBV感染（HBsAg阴性但HBcAb阳性）114例（36.4%），发生率略高于普通人群（34.1%）。②HBsAg阳性组与阴性组比较，B细胞型比例（87.2%对70.3%，P = 0.027）、Ann Arbor分期Ⅲ - Ⅳ期（69.2%对34.6%，P ＜0.001）、国际预后指数（IPI）评分3 - 5分（74.4%对50%，P = 0.004）、乳酸脱氢酶（LDH）水平（79.5%对47.8%，P ＜0.001）及肝脏受累情况（45.5%对31.7%，P = 0.006）均更高。差异有统计学意义。③HBV感染组（114例）与未感染组（160例）比较，Ann Arbor分期Ⅲ - Ⅳ期比例（P = 0.023）及IPI评分3 - 5分（P = 0.035）差异有统计学意义。④HBV DNA阳性组（30例）与阴性组（71例）比较，患者Ann Arbor分期Ⅲ - Ⅳ期比例（P = 0.011）、IPI评分3 - 5分（P = 0.030）、LDH水平（P = 0.025）及肝脏受累情况（P ＜0.001）差异有统计学意义。阳性患者以1×10⁵拷贝/ml为界分为HBV DNA高、低拷贝组，结果显示两组间差异无统计学意义（P ＞0.05）。NHL患者HBV感染率显著高于普通人群，且HBV感染与B细胞型NHL关系更为密切。HBV感染及HBV DNA阳性患者Ann Arbor分期晚、IPI评分高、LDH水平高及有肝脏受累，预后差。
