老年弥漫性大B细胞淋巴瘤患者化疗营养状态与毒副反应及预后的关系

Correlation of Nutritional Status with Toxicity and Prognosis in Elderly Patients with Diffuse Large B-Cell Lymphoma Undergoing Chemotherapy

目的分析老年弥漫性大B细胞淋巴瘤(DLBCL)患者化疗营养状态与毒副反应及预后的关系。方法将郑州大学第一附属医院2017年3月至2018年3月收治的72例接受化疗的DLBCL患者作为研究对象,根据其化疗前1周内血生化检查结果计算小野寺预后营养指数(PNI)。根据患者是否发生Ⅱ级以上化疗毒副反应将其分为严重不良反应组与轻度不良反应组,绘制受试者工作特征(ROC)曲线,计算约登指数,确定PNI预测DLBCL患者化疗严重不良反应的最佳临界值,采用Kaplan-Meier生存曲线与Cox风险回归模型分析影响DLBCL患者预后的相关因素。结果DLBCL化疗患者中<60岁患者的PNI值高于≥60岁者,Ann-Arbor分期Ⅰ~Ⅱ期者PNI值高于Ⅲ~Ⅳ期者,美国东部肿瘤协作组(ECOG)评分0~1分者PNI值高于2~3分者(P<0.05)。血小板下降、发热、神经毒性是DLBCL患者化疗后发生率最高的3种毒副反应。出现Ⅱ级以上毒副反应者共29例(严重不良反应组),Ⅱ级及以下毒副反应者共43例(轻度不良反应组)。轻度不良反应组化疗前PNI水平高于严重不良反应组(P<0.05)。绘制ROC曲线发现,PNI小于51.50时,其预测老年DLBCL患者化疗严重不良反应的曲线下面积(AUC)=0.845(95%CI:0.755~0.936)。多因素回归分析提示,吸烟、乳酸脱氢酶升高及PNI高水平均是影响DLBCL化疗患者预后的独立危险因素。结论化疗前PNI值降低可预测DLBCL化疗患者严重不良反应,并与患者年龄、临床分期及体力评分相关,且PNI值还是影响DLBCL患者预后的独立因素,可作为临床预测DLBCL患者化疗不良反应严重程度、评估患者预后的参考指标。

Objective To analyze the correlation of nutritional status with toxicity and prognosis in elderly patients with diffuse large B-cell lymphoma(DLBCL)undergoing chemotherapy.Methods Seventy-two patients with DLBCL undergoing chemotherapy in the First Affiliated Hospital of Zhengzhou University from March 2017 to March 2018 were enrolled.Onodera’s prognostic nutritional index(PNI)of peripheral blood within 1 week before surgery was calculated.Patients were classified into severe side effects group and mild side effects group according to the toxicities of gradeⅡor higher.The receiver operating characteristic(ROC)curve was drew,and Youden index was calculated.The optimal cut-off value of PNI for predicting severe adverse reactions in patients with DLBCL undergoing chemotherapy was determined.Then the Kaplan-Meier survival curve and Cox risk regression model analysis were applied to screen the relevant factors affecting the prognosis of DLBCL patients.Results Among DLBCL chemotherapy patients,the PNI value of patients<60 years old was higher than that≥60 years,the PNI value of patients in Ann-Arbor stageⅠ-Ⅱwas higher than that in stageⅢ-Ⅳ,the PNI value of patients with Eastern Cooperative Oncology Group(ECOG)scoring 0-1 points was higher than that in scoring 2-3(P<0.05).Thrombocytopenia,fever and neurotoxicity were the three most frequent toxicities after chemotherapy in DLBCL patients.There were 29 cases of gradeⅡor above toxicities(severe side effects group)and 43 cases of gradeⅡor below toxicities(mild side effects group).PNI before chemotherapy in mild side effects group was higher than that in severe side effects group(P<0.05).ROC curve found that PNI less than 51.50 had an area under curve(AUC)of 0.845(95%CI:0.755-0.936)in predicting severe side effects of chemotherapy in elderly DLBCL patients.Multivariate regression analysis denoted that smoking,elevated lactate dehydrogenase and increased PNI were independent risk factors affecting the prognosis of patients with DLBCL undergoing chemotherapy.Conclusion A reduced PNI value before chemotherapy is predictive of severe chemotherapy side effects in patients with DLBCL and is associated with patient age,clinical stage and physical performance score,and PNI value is also an independent prognostic factor in patients with DLBCL,which can be used as a clinical reference for predicting the severity of side effects of chemotherapy in patients with DLBCL and evaluating the prognosis of patients.