滤泡性淋巴瘤患者外周血CD4^+T细胞检测的临床意义

Clinical Significance of Detecting CD4^+ T Cells in Peripheral Blood of Patients with Follicular lymphoma

目的:探讨滤泡性淋巴瘤患者外周血标本CD4^+T淋巴细胞的变化及临床意义。方法:收集血标本检测所有患者全血细胞,包括单核细胞绝对数(AMC)、淋巴细胞绝对数(ALC)、血红蛋白(Hb)、血小板(Plt)。记录患者年龄、性别、病理分级、累及的淋巴结数目,骨髓受累(BMI)、Ann Arbor分期,B症状,血清乳酸脱氢酶(LDH)和血清β-2微球蛋白(β2-MG)的水平。使用FLIPI和FLIPI-2进行预后分层,采用流式细胞仪分析T淋巴细胞亚群,包括CD4^+T淋巴细胞绝对数(ACD4C)和CD8^+T淋巴细胞绝对数(ACD8C)。结果:Ann Arbor分期较高、Hb<120 g/L、LDH大于正常上限、累及淋巴结数目>4、累及骨髓者、高β2-MG水平、FLIPI评分和FLIPI-2评分较高者,其AMC水平亦较高(P<0.05)。不同因素分组的ACD4C水平差异均无统计学意义。AMC≥0.89×10~9/L患者较AMC<0.89×10~9/L的患者无进展生存期和总生存期更短(P=0.010,0.002)。ACD4C>0.16×10~9/L患者较ACD4C≤0.16×10~9/L患者无进展生存期和总生存期更长(P=0.016,0.012)。低ACD4C和高AMC与较短的PFS和OS相关(P=0.013,0.020)。单变量Cox回归分析显示年龄(P=0.026)、累及骨髓(P=0.017)、升高的LDH(P=0.001)、β2-MG(P=0.014)、FLIPI(P=0.004)和FLIPI-2评分(P=0.000)与较短的PFS相关。而较短时的OS与Hb(P=0.015)、升高的LDH(P=0.003)、β2-MG(P=0.045)、累及骨髓(P=0.016)和FLIPI-2评分(P=0.003)相关。多变量Cox回归分析显示,ACD4C≤0.16×10~9/L是影响FL预后(PFS和OS)的因素(P<0.05)。结论:低ACD4C水平与FL患者预后不良有关,ACD4C水平可作为判断FL病情和预后的重要指标。

Objective：To investigate the changes of CD4^＋ T lymphocytes in peripheral blood of patients with follicular lymphoma and its clinical significance. Methods：Blood samples were collected for detection of whole blood cells, including absolute monocyte count （AMC）, absolute lymphocyte count （ALC）, hemoglobin （Hb）, platelet count （Plt）. Age, sex, pathological grade, number of involved lymph nodes, bone marrow involvement （BMI）, Ann Arbor stage, B symptoms, serum lactate dehydrogenase （LDH） and serum β -2 microglobulin （β2 -MG ） were recorded, the prognostic stratification was performed by using FLIPI and FLIPI- 2. The T lymphocyte subsets were analyzed by flow cytornetry, including the absolute number of CD4^＋ T lymphocytes （ACD4C） and the absolute number of CD8^＋ T lymphocytes （ACD8C）. Results：Patients were with higher Ann Arbor stage, Hb 〈 120 g/L, LDH greater than the upper limit of normal, the number of lymph nodes were involved 〉 4, the bone marrow was involvement, 132 - MG levels were high FLIPI score and FLIPI - 2 score, AMC level was higher （ P 〈 0. 05 ）. There were no significant differences in ACD4C levels among different groups. Patients with AMC≥0.89×10^9/L showed a shorter progressionfree survival （PFS） and a shorter overall survival time （OS） （P =0. 010,0. 002） as compared with patients with AMC 〈0. 89 ×10^9/L. The patients with ACD4C 〉 0. 16×10^9/L had longer progression-free survival and overall survival time, as compared with patients with ACD4C ≤0. 16×10^9/L （P =0. 016,0. 012）. Low ACD4C and high AMC related with shorter PFS and OS （P =0. 013, 0. 020）. Univariate Cox regression analysis showed that age （P = 0. 026 ）, bone marrow involvement （ P = 0. 017 ）, elevated LDH （ P = 0. 001 ）, β2 - MG （ P = 0. 014 ）, FLIPI and FLIP2 score （ P = 0. 004 and 0.000） related with a shorter PFS. Multivariable Cox regression analysis showed that Hb （P = 0. 015 ）, elevated LDH （P =0. 003）, 132 - MG （P =0. 045）, bone marrow involvement （P =0. 016） and FLIPI - 2 score（P =0. 003 ） related with short OS. ACD4C ≤0. 16 ×10^9/L was a factor influencing prognosis of FL patients （ PFS and OS ） （ P 〈 0.05 ）. Conclusions： Low ACD4C levels relatees with poor prognosis of patients with FL, and the ACD4C levels may be an important predictor for FL disease and prognosis.