B细胞非霍奇金淋巴瘤患者治疗后发生间质性肺炎的临床分析

Risk factors of interstitial pneumonia in patients with B-cell non-Hodgkin s lymphoma after treatment

目的探讨B细胞非霍奇金淋巴瘤(NHL)患者治疗后发生间质性肺炎(IP)的临床病理特征、相关因素及治疗转归。方法收集2015年1月至2020年10月1163例B细胞NHL患者的临床病理资料,其中94例发生IP(病例组),另随机抽取未发生IP的95例患者作为对照组。主要治疗方案包括R-CHOP、CHOP、R-CDOP和CDOP。归纳总结IP治疗转归,并采用Logistic回归模型分析影响IP发生的因素。结果B细胞NHL患者治疗后IP的发生率为8.1%(94/1163)。单因素分析显示,年龄,心肺基础疾病,IPI评分,结外侵犯部位数量,应用含利妥者单抗(RTX)和聚乙二醇脂质体阿霉素(PLD)的方案,治疗前后乳酸脱氢酶(LDH)、红细胞沉降率(ESR)和中性粒细胞绝对值的变化与IP的发生有关(P<0.05);Logistic多因素分析显示,应用含RTX的方案,治疗前后LDH和ESR水平变化以及IPI评分是影响IP发生的独立因素(P<0.05);受试者工作特征(ROC)曲线分析显示,治疗前后LDH变化预测IP发生的曲线下面积(AUC)为0.584,灵敏度和特异度分别为66.0%和54.7%;治疗前后ESR变化预测IP发生的AUC为0.788,特异度和灵敏度为83.2%和67.0%。IP多发生在治疗第3和第4周期,70例患者接受治疗,68例患者经治疗后症状及体征缓解,2例患者因IP引发呼吸衰竭而死亡。结论在B细胞NHL患者中应用含RTX的方案进行第3和第4周期治疗时,需要加强IP的预防和监测,尤其是IPI评分中高危,治疗后较治疗前LDH、ESR水平升高的患者。

Objective To investigate the clinicopathological features,related factors and treatment outcome of interstitial pneumonia(IP)in patients with B-cell non-Hodgkin lymphoma(NHL)after treatment.Methods Clinical data of 1163 cases of B cell NHL patients from January 2015 to October 2020 were collected.IP occurred in 94 patients,and 95 cases without IP were randomly enrolled as control.The treatment outcome of IP was summarized,and Logistic regression model was used to analyze the factors affecting the occurrence of IP.Results The incidence of IP in patients with B cell NHL after treatment was 8.1%(94/1163).Univariate analysis showed that age,basic cardiopulmonary diseases,IPI score,number of extranodal invasion sites,the application of rituximab(RTX)and pegylated liposomaldoxorubicin(PLD),changes in lactate dehydrogenase(LDH),erythrocyte sedimentation rate(ESR)and absolute value of neutrophils before and after treatment were related to the occurrence of IP(P<0.05);The results of Logistic multivariate analysis showed that the changes of LDH and ESR levels before and after treatment,IPI scores,and the application of RTX were independent factors affecting the occurrence of IP(P<0.05);The receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the change of LDH before and after treatment to predict the occurrence of IP was 0.584,and the sensitivity and specificity were 66.0%and 54.7%respectively;The AUC of ESR changes before and after treatment for predicting IP was 0.788,and the specificity and sensitivity were 83.2%and 67.0%.IP mostly occurred in the third and fourth cycles of treatment.Seventy patients received treatment,68 patients symptoms and signs were relieved after treatment,and 2 patients died of respiratory failure caused by IP.Conclusion IP prevention and monitoring should be strengthened when RTX containing regimens are used in the third to fourth cycles of treatment in patients with B-cell NHL,especially in patients with high IPI scores and higher LDH and ESR levels after treatment.