侵袭性非霍奇金淋巴瘤患者化疗后感染的临床免疫因素分析

Analysis of immune factors influencing the infection after chemotherapy in patients with aggressive non-Hodgkin's lymphoma

目的：探讨侵袭性非霍奇金淋巴瘤（NHL）患者化疗后感染的临床免疫影响因素。方法：选取2008—01—2013—12接受CHOP样方案化疗的98例侵袭性NHL患者，于化疗前检测T淋巴细胞亚群，NK细胞，免疫球蛋白（IgG，IgA，IgM）及补体（C3，C4），调查化疗后（31d内）感染情况。通过单因素与多因素分析了解化疗后感染与临床免疫因素等的关系。结果：98例患者中发生感染29例，占29．6％。感染部位主要为呼吸道，感染程度以CTCAE3级最多见，病原菌以革兰氏阴性菌为主。单因素分析显示，感染者化疗前CD4＋T细胞计数，CD8＋T细胞计数，以及IgM均显著小于未感染者[（0．24±0．14）×10^9／L,（0．44±0．21）×10^9／L，（0．29±0．20）×10^9／L：（0．43±0．20）×10^9／L，0．50g／L,0．70g／L，P〈0．05]。二元Logistic回归分析显示，化疗前CD4＋T细胞计数与化疗后感染有关（P=0．002，0R0．001，95％C10．000～0．060）。结论：化疗前CD4＋T细胞计数是侵袭性NHL患者化疗后感染的重要影响因素，CD4＋T细胞计数越低，化疗后感染风险越大。

Objective： To investigate immune factors influencing the infection after chemotherapy in patients with aggressive non-Hodgkin＇s lymphoma （NHL）. Method： T-lymphocyte subsets, NK cells, immunoglobulin （IgG, IgA, IgM）, and complement （C3, C4） were quantified before chemotherapy （day 0） in 98 patients with aggressive NHL treated with CHOP-like chemotherapy from January 2008 to December 2013. Correlations between immune factors, clinical characteristics, and the risk of infection within 31 days after chemotherapy were investigated in univariate and multivariate analyses. Result： The infectious episode occurred in 29 of 98 patients （29.6 %）. The most common infective site was respiratory tract （17/29）. CTCAE Grade 3 was the main severity of infection. The majority of pathogens were Gram-negative bacteria. CD4＋T cells before chemotherapy in infective cases were significantly less than those of uninfected cases in univariate analyses [（0.24±0.14） ×10^9/L vs （0.44±0.21） × 10^9/L,（0.29±0.20） ×10^9/L vs （0.43±0.20） × 10^9/L,0.50 g/L vs 0.70 g/L,P〈0.05]. Binary logistic regression analysis revealed CD4＋T cell count before chemotherapy was associated with the infection risk after chemotherapy （P=0. 002,OR 0. 001,95%CI 0. 000-0. 060）. Conclusion： CD4＋ T cell count before chemotherapy is an important factor for infection after chemotherapy in patients with aggressive NHL. The lower the CD4＋ T cell count is, the greater risk of infection after chemotherapy.