弥漫大B细胞淋巴瘤患者血清肿瘤负荷相关指标与临床分期、治疗效果及临床预后的关系

The relationship between serum tumor burden-related indicators and clinical stage,treatment effect and prognosis in patients with diffuse large B-cell lymphoma

目的分析弥漫大B细胞淋巴瘤(DLBCL)患者血清乳酸脱氢酶(LDH)、β2微球蛋白(β2-MG)、铁蛋白、癌胚抗原125(CA125)水平表达与临床分期、治疗效果及临床预后的关系。方法选择2016年12月—2018年12月江南大学附属医院血液内科收治的DLBCL患者91例作为研究对象,检测患者血清LDH、β2-MG、铁蛋白、CA125水平,并分析其与DLBCL患者临床病理参数、治疗效果及预后的关系。结果Ann Arbor分期Ⅲ~Ⅳ期、国际标准预后(IPI)分级高中危和高危、治疗无效、死亡患者血清LDH、β2-MG、铁蛋白、CA125水平高于Ann Arbor分期Ⅰ~Ⅱ期、IPI预后分级低危和低中危、治疗有效和存活患者(P<0.05);存在B症状患者血清LDH、CA-125水平升高(P<0.05),而血清β2-MG、铁蛋白水平比较差异无统计学意义(P>0.05)。Spearman相关分析表明,LDH、β2-MG、铁蛋白、CA125均与Ann Arbor分期、IPI预后分级、疗效、预后呈正相关(P<0.05),LDH、CA125与B症状呈正相关(P<0.05)。ROC曲线分析结果显示,LDH、β2-MG、铁蛋白、CA125及4项联合检测对DLBCL诊断的AUC分别为0.884(95%CI 0.804~0.965)、0.777(95%CI 0.662~0.893)、0.736(95%CI 0.626~0.847)、0.795(95%CI 0.706~0.884)、0.936(95%CI 0.856~0.987)。多因素Cox风险回归分析显示,LDH(2.040,95%CI 1.260~3.304)、β2-MG(1.766,95%CI 1.358~2.296)、铁蛋白(1.540,95%CI 1.098~2.161)、CA125(1.806,95%CI 1.454~3.547)与DLBCL患者不良预后相关。结论血清LDH、β2-MG、铁蛋白、CA125与DLBCL临床分期、治疗效果和预后有关,高水平的LDH、β2-MG、铁蛋白、CA125均会增加DLBCL患者不良预后的风险,且4项联合检测对预测DLBCL患者预后具有较高效能,有望作为DLBCL预后预测的可靠手段。

Objective To analyze the expression of serum lactate dehydrogenase(LDH),β2 microglobulin(β2-MG),ferritin,carcinoembryonic antigen 125(CA125)levels in patients with diffuse large B-cell lymphoma(DLBCL)and their clinical stage,therapeutic effect and clinical prognosis relationship.Methods We selected 91 DLBCL patients admitted to the Department of Hematology,Jiangnan University Affiliated Hospital from December 2016 to December 2018 as the research objects to detect serum LDH,β2-MG,ferritin,and CA125 levels.And analyze its relationship with clinicopathological parameters,treatment effect and prognosis of DLBCL patients.Results Ann Arbor stagingⅢ~Ⅳ,international standard prognosis(IPI)classification of high-medium risk and high-risk,treatment failure,serum LDH,β2-MG,ferritin,and CA125 levels in patients who died are higher than Ann Arbor's stagingⅠ-Ⅱ,IPI prognostic classification is low-risk And low-medium-risk,treatment-effective and surviving patients(P<0.05);serum LDH and CA125 levels in patients with B symptoms increased(P<0.05),but there was no significant difference in serumβ2-MG and ferritin levels(P>0.05).Spearman correlation analysis showed that LDH,β2-MG,ferritin,and CA125 were positively correlated with Ann Arbor staging,IPI prognostic grading,efficacy,and prognosis(P<0.05),and LDH,CA125 and B symptoms were positively correlated(P<0.05).ROC curve analysis showed that the AUC of LDH,β2-MG,ferritin,CA125 and 4 combined tests for DLBCL diagnosis were 0.884(95%CI 0.804~0.965),0.777(95%CI 0.662~0.893),0.736(95%CI 0.626~0.847),0.795(95%CI 0.706~0.884),0.936(95%CI 0.856~0.987).Multivariate Cox risk regression analysis showed that the prognostic classification of IPI(1.647,95%CI 1.102~2.351),LDH(2.040,95%CI 1.260~3.304),β2-MG(1.766,95%CI 1.358~2.296),ferritin(1.540),95%CI 1.098~2.161),CA125(1.806,95%CI 1.454~3.547)are related to the poor prognosis of DLBCL patients.Conclusion Serum LDH,β2-MG,ferritin,and CA125 are related to the clinical stage,treatment effect,and prognosis of DLBCL.High levels of LDH,β2-MG,ferritin,and CA125 all increase the risk of poor prognosis in patients with DLBCL,and the 4 combined tests can predict DLBCL patients The prognosis has high efficacy and is expected to be a reliable method for predicting the prognosis of DLBCL.