乳酸脱氢酶、β2-微球蛋白联合检测对非霍奇金淋巴瘤预后判断的意义

Prognostic significance of serum LDH and β2-MG in non-Hodgkin＇s lymphoma

目的探讨血清中乳酸脱氢酶（LDH）、β2-微球蛋白（β2-MG）水平与非霍奇金淋巴瘤（NHL）患者临床特征及预后的关系。方法选择NHL患者429例，检测两种血清标志物水平，按性别、年龄、B症状、分期、结外病变部位数等分组比较，同时随访患者的生存时间，并对上述因素进行生存分析。结果LDH和β2-MG水平在Ⅲ～Ⅳ期患者中均明显高于I～Ⅱ期患者（中位值：LDH分别为252、175U／L，β2-MG分别为2．5、1．6mg／L），有B症状组明显高于无B症状组（中位值：LDH分别为260、192U／L，β2-MG分别为2．3、1．7mg／L），60岁以上患者高于60岁及以下患者（中位值：LDH分别为229、190U／L，β2-MG分别为2．4、1．7mg／L），两个及以上结外病变患者高于两个以下患者（中位值：LDH分别为278、195U／L，β2-MG分别为2．4、1．8mg／L），Karnofsky评分≤70分患者高于Karnofsky评分〉70分患者（中位值：LDH分别为250、195U／L，β2-MG分别为2．2、1．8mg／L）；侵袭性淋巴瘤患者的LDH水平高于惰性患者（中位值：分别为211、175U／L），而两组β2-MG水平则差异无统计学意义；LDH和β2-MG水平与性别、细胞分型均无关。LDH正常组和升高组总体生存率差异有统计学意义（X^2=119．029，P〈0．001），β2-MG正常组和升高组总体生存率差异有统计学意义（X^2=104．733，P〈0．001），LDH、β2-MG均升高组的总体生存率明显低于两者均正常组（X^2=192．326，P〈0．001）。Cox回归分析显示LDH、β2-MG、年龄、临床分期、结外病变部位数、Karnofsky评分及侵袭性是NHL患者生存的独立影响因素。结论联合检测血清LDH和β2-MG水平可作为NHL患者分期及预后的评估指标。

Objective To investigate the significance of the expression of serum LDH and β2-MG in predicting survival of NHL patients and there correlations with clinical parameters. Methods The serum levels of LDH and β2-MG of 429 patients with NHL were measured by rate method and immunoturhidimetry. Besides, the clinical reference of the patients such as gender, age, B symptoms, clinical stages, extranodal sites and Karnofsky evaluation were summarized and grouped. All patients＇ survival status were achieved via phone and letter. All statistical analyses were performed using the SPSS program for Windows （version 16.0）. Results The levels of LDH and β2-MG in age, B symptom, the advanced stage, extranodal sites≥2, Karuofsky evaluation were obviously higher than their counterpart and the difference was significant （P〈0.001）. The median of LDH and β2-MG lever in age group was 229 U/L,190 U/L, 2.4 rag/L,1.7 mg/L. In B symptom was 260 U/L,192 U/L,2.3 rag/L, 1.7 mg/L. In clinical stage was 252 U/L, 175 U/L, 2.5 mg/L, 1.6 mg/L. In extranodal sites group was 278 U/L, 195 U/L, 2.4 mg/L, 1.8 mg/L. In Kamofsky evaluation group was 250 mg/L, 195 mg/L, 2.2 mg/L, 1.8 mg/L. LDH level of invasive lymphoma was significantly higher than that of indolent ones （median 211 U/L,175 U/L,P=0.002）,but there were no difference in the β2-MG level （P=0.937）. There were no statistical significance about LDH and β2-MG levels in gender and cell type （P〉0.05）. Overall survival rates were different between the abnormal LDH group and the normal LDH group （X^2=119.029, P〈0.001）. Overall survival rates were different between the elevated β2-MG group and the normal β2-MG group （X^2 = 104.733, P〈0.001）. Overall survival rates of the abnormal LDH/β2-MG group was significantly lower than that of normal group （X^2=192.326, P〈0.001）. Multivariate analysis in Cox regression showed that LDH, β2-MG,age,clinical stages, extranodal sites, Karnofsky evaluation and aggressive were independent prognostic factors. Conclusion The level of serum LDH and β2-MG can be taken as an auxiliary clinical index to evaluate the prognosis of the NHL patients.