乙型肝炎病毒感染与弥漫性大 B 细胞淋巴瘤患者的病毒学血清标志物的作用。
Role of virological serum markers in patients with both hepatitis B virus infection and diffuse large B-cell lymphoma.
机构信息
Department of Internal Medicine V, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany.
Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany.
出版信息
Eur J Haematol. 2019 Oct;103(4):410-416. doi: 10.1111/ejh.13300. Epub 2019 Aug 7.
BACKGROUND
Causality between hepatitis B virus (HBV) infection and diffuse large B-cell lymphoma (DLBCL) was reported in various studies. However, the implication of different virological serum markers of HBV infection in patients with both HBV infection and DLBCL is not fully understood. The aim of this study was to investigate the impact of HBV markers on overall survival (OS) and progression-free survival (PFS) in patients with both HBV infection and DLBCL.
METHODS
In this study, patients (n = 40) diagnosed with both HBV infection and DLBCL were identified between 2000 and 2017. Six patients with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) co-infection were excluded from this study. We retrospectively analyzed patients' demographic characteristics, treatment, and the prognostic impact of different HBV markers at first diagnosis of DLBCL (HBsAg, anti-HBs, HBeAg, anti-HBe, and HBV-DNA) on OS and PFS.
RESULTS
The majority of patients (n = 21, 62%) had advanced disease stage (III/IV) at diagnosis. In the first-line therapy, 24 patients (70%) were treated with R-CHOP regimen (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone). HBeAg positive patients had a trend toward inferior OS and PFS compared with HBeAg negative patients. Anti-HBe positive patients had a statistically significant better OS and PFS compared with anti-HBe negative group (both P < .0001). Viremia with HBV-DNA ≥ 2 × 10 IU/L had a significant negative impact on OS and PFS (both P < .0001).
CONCLUSION
High activity of viral replication is associated with a poor survival outcome of patients with both HBV infection and DLBCL.
背景
乙型肝炎病毒（HBV）感染与弥漫性大 B 细胞淋巴瘤（DLBCL）之间的因果关系在各种研究中均有报道。然而，HBV 感染的不同病毒学血清标志物在 HBV 感染和 DLBCL 患者中的意义尚不完全清楚。本研究旨在探讨 HBV 标志物对 HBV 感染和 DLBCL 患者总生存（OS）和无进展生存（PFS）的影响。
方法
本研究纳入了 2000 年至 2017 年间诊断为 HBV 感染和 DLBCL 的患者（n=40）。排除了 6 例同时感染丙型肝炎病毒（HCV）和/或人类免疫缺陷病毒（HIV）的患者。我们回顾性分析了患者的人口统计学特征、治疗方法以及首次诊断为 DLBCL 时不同 HBV 标志物（HBsAg、抗-HBs、HBeAg、抗-HBe 和 HBV-DNA）对 OS 和 PFS 的预后影响。
结果
大多数患者（n=21，62%）在诊断时处于晚期疾病阶段（III/IV 期）。在一线治疗中，24 例患者（70%）接受了 R-CHOP 方案（利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松）治疗。与 HBeAg 阴性患者相比，HBeAg 阳性患者的 OS 和 PFS 有下降趋势。与 HBeAg 阴性组相比，抗-HBe 阳性患者的 OS 和 PFS 有显著统计学差异（均 P<.0001）。HBV-DNA≥2×10 IU/L 的病毒血症与患者 OS 和 PFS 的显著负相关（均 P<.0001）。
结论
病毒复制的高活性与 HBV 感染和 DLBCL 患者的不良生存结局相关。
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