弥漫大B细胞淋巴瘤患者化疗前后淋巴细胞亚群动态变化及其意义

Dynamic changes of lymphocyte subsets in patients with diffuse large B-cell lymphoma before and after chemotherapy and its significance

目的探讨弥漫大B细胞淋巴瘤(DLBCL)患者化疗前后外周血中淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平变化及其临床意义。方法回顾性选取安徽医科大学省立医院2018年5月~2020年5月首次就诊的56例DLBCL患者作为研究对象,所有患者均经病理确诊,按照化疗前外周血CD4^(+)/CD8^(+)比值分为升高/正常组(A组)39例和降低组(B组)17例,患者入院后均行R-CHOP方案,化疗四周期后再按照外周血CD4^(+)/CD8^(+)比值分为升高/正常组(C组)31例和降低组(D组)25例,分析不同临床特征患者的免疫功能变化及与预后的关系。结果治疗后两组患者的CD3^(+)、CD8^(+)水平高于治疗前,CD4^(+)/CD8^(+)低于治疗前,差异有统计学意义(P<0.05)。治疗后A组病情进展的患者少于B组,A组患者治疗后无进展生存时间长于B组,差异有统计学意义(P<0.05)。D组血小板减少发生率高于C组,差异有统计学意义(P<0.05)。结论化疗前后DLBCL患者的免疫状况发生改变,检测外周血淋巴细胞亚群水平对评估诊疗有较高的价值,患者外周血免疫细胞监测可以及时判断患者免疫状态,以期更好地指导化疗药物使用。

Objective To investigate the changes of lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))in peripheral blood before and after chemotherapy in patients with diffuse large B-cell lymphoma(DLBCL)and their clinical significance.Methods A total of 56 patients with DLBCL who visited Provincial Hospital affiliated to Anhui Medical University for the first time from May 2018 to May 2020 were retrospectively selected as the research subjects,and all patients were pathologically confirmed.According to the ratio of CD4^(+)/CD8^(+)in peripheral blood before chemotherapy,the patients were divided into two groups as the elevated/normal group(group A)39 cases and the reduced group(group B)17 cases.All patients received R-CHOP regimen after admission,After four cycles of chemotherapy,the patients were divided into elevated/normal group(group C)31 cases and decreased group(group D)25 cases according to the ratio of CD4^(+)/CD8^(+)in peripheral blood,and analyzed the changes of immune function and its relationship with prognosis in patients with different clinical characteristics.Results After treatment,the levels of CD3^(+)and CD8^(+)in two groups were higher than before treatment,while the level of CD4^(+)/CD8^(+)was lower than before treatment,the differences were statistically significant(P<0.05).After treatment,the patients in group A had less progression than group B,and the progression-free survival time in group A was longer than that in group B,the differences were statistically significant(P<0.05).The incidence of thrombocytopenia in group D was higher than that in group C,and the difference was statistically significant(P<0.05).Conclusion The immunestatus of patients with diffuse large B-cell lymphoma have changed,and the detection of peripheral blood lymphocyte subsets was of high value for the evaluation and diagnosis.Peripheral blood immune cell monitoring of patients could timely determine the immune status of patients in order to better guide the use of chemotherapy drugs.