[外周血淋巴细胞/单核细胞比值（LMR）及其与乳酸脱氢酶的比值对弥漫性大B细胞淋巴瘤患者预后的影响]
[Influence of Peripheral Blood Lymphocyte/Monocyte ratio (LMR) and Its Ratio to Lactate Dehydrogenase on Prognosis of Patients with Diffuse Large B-Cell Lymphoma].
作者信息
Yang Di, Su Li-Ping
机构信息
Graduate School of Shanxi Medical University, Department of Hematology, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, Shanxi Province, China.
Graduate School of Shanxi Medical University, Department of Hematology, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, Shanxi Province, China,E-mail:
出版信息
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Oct;28(5):1563-1569. doi: 10.19746/j.cnki.issn.1009-2137.2020.05.023.
OBJECTIVE
To explore the influence of lymphocyte / monocyte ratio (LMR), LMR/lactate dehydrogenase (LDH) ratio on the prognosis of patients with diffuse large B-cell lymphoma.
METHODS
Clinical data of 107 newly diagnosed patients with DLBCL, including age, sex, stage, B symptoms, IPI score, ECOG score, absolute lymphocyte count, absolute value of monocytes, the ratio of lymphocyte to monocyte(LMR), LDH, LMR/LDH, and SUVmax detected by FDG-PET/CT were analyzed. The best cut-off points of LMR and LMR/LDH were determined by receiver operating characteristics (ROC) curve; the chi-square test was used to analyze the correlation of clinical factors with LMR and LMR/LDH; Spearman correlation analysis was used to determine the correlation between serum LDH level and SUVmax; the Kaplan-Meier protocol was used to compare the overall survival (OS) rate and progression-free survival (PFS) rate between LMR and LMR/LDH groups; the Cox proportional risk model was used to carry out the multivariate analysis of prognostic factors.
RESULTS
The optimal limit value for LMR and LMR/LDH (%) determined by ROC curve was 2.535 （P＜0.05） and 0.35% （P＜0.01） respectively. Patients with an LMR<2.535 had a higher incidence of advanced Ann Arbor stage, B symptoms, higher IPI score, higher ECOG score, and elevated LDH level, while patients with LMR/LDH 0.35% had the same trend as patients with LMR <2.535. A significant positive correlation between serum LDH and SUVmax was observed by Spearman correlation analysis (P<0.001). K-M survival analysis showed that the PFS rate and OS rate in high LMR group were significantly better than that in the low LMR group (P<0.05). K-M analysis showed that the PFS rate and OS rate in high LMR/LDH group were statistical significantly better than that in low LMR/LDH group (P<0.05). Multivariate COX analysis showed that the predictive value in LMR/LDH was much better than single LMR, which may be an independent prognostic factor for patients with DLBCL.
CONCLUSION
At the initial diagnosis, high LMR/LDH suggests that DLBCL patient is a better prognosis.
目的
探讨淋巴细胞/单核细胞比值（LMR）、LMR/乳酸脱氢酶（LDH）比值对弥漫性大B细胞淋巴瘤患者预后的影响。
方法
分析107例新诊断的弥漫性大B细胞淋巴瘤患者的临床资料，包括年龄、性别、分期、B症状、国际预后指数（IPI）评分、美国东部肿瘤协作组（ECOG）评分、淋巴细胞绝对计数、单核细胞绝对值、淋巴细胞与单核细胞比值（LMR）、LDH、LMR/LDH以及通过氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）检测的最大标准摄取值（SUVmax）。通过受试者工作特征（ROC）曲线确定LMR和LMR/LDH的最佳截断点；采用卡方检验分析临床因素与LMR和LMR/LDH的相关性；采用Spearman相关性分析确定血清LDH水平与SUVmax之间的相关性；采用Kaplan-Meier法比较LMR和LMR/LDH分组之间的总生存率（OS）和无进展生存率（PFS）；采用Cox比例风险模型对预后因素进行多因素分析。
结果
ROC曲线确定的LMR和LMR/LDH（%）的最佳限值分别为2.535（P＜0.05）和0.35%（P＜0.01）。LMR<2.535的患者Ann Arbor分期晚期、B症状、IPI评分较高和ECOG评分较高以及LDH水平升高的发生率较高，而LMR/LDH<0.35%的患者与LMR<2.535的患者具有相同趋势。Spearman相关性分析显示血清LDH与SUVmax之间存在显著正相关（P<0.001）。K-M生存分析显示，高LMR组的PFS率和OS率显著优于低LMR组（P<0.05）。K-M分析显示，高LMR/LDH组的PFS率和OS率在统计学上显著优于低LMR/LDH组（P<0.05）。多因素COX分析显示，LMR/LDH的预测价值优于单一LMR，可能是弥漫性大B细胞淋巴瘤患者的独立预后因素。
结论
在初诊时，高LMR/LDH提示弥漫性大B细胞淋巴瘤患者预后较好。
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