C反应蛋白/白蛋白比值在胃黏膜相关淋巴组织淋巴瘤中的预后预测价值

Prognostic value of the C-reactive protein/albumin ratio in gastric mucosa-associated lymphoid tissue lymphoma

目的 探讨C反应蛋白与白蛋白比值(C-creative protein/albumin ratio, CAR)预测胃黏膜相关淋巴组织(MALT)淋巴瘤患者预后的价值。方法 纳入2004年1月至2020年6月在复旦大学附属中山医院初诊的胃MALT淋巴瘤患者,计算其CAR。通过X-tile软件获取最佳CAR临界值,将患者分为低CAR组和高CAR组。收集两组患者的基线数据及生存资料。应用Cox分析和Kaplan-Meier法分析CAR在胃MALT淋巴瘤的预后预测意义。结果 CAR的最佳临界值为0.05。与低CAR组(CAR<0.05,n=66)相比,高CAR组(CAR≥0.05,n=27)中高龄(70岁以上)、贫血患者更多,C反应蛋白水平、β2-微球蛋白水平更高,白蛋白水平更低(P<0.05)。Cox多因素分析示IgG为患者预后的独立预测因素(HR=0.528,95%CI 0.304~0.915, P=0.023)。低CAR组中位总生存期(overall survival,OS)长于高CAR组(172.8个月vs 112.7个月,P=0.020)。不同MALT-IPI评分组患者OS差异无统计学意义;CAR联合MALT-IPI评分2分患者OS明显短于0分和1分患者(P<0.05)。结论 高CAR组患者预后更差,CAR可用于评估胃MALT淋巴瘤患者预后。

Objective To investigate the prognostic value of C-reactive protein/albumin ratio(CAR)in gastric mucosa-associated lymphoid tissue(MALT)lymphoma.Methods The patients with gastric MALT lymphoma initially diagnosed in Zhongshan Hospital,Fudan University from January 2004 to June 2020 were included,and CAR values were calculated.These patients were divided into a low-CAR group(n=66)and a high-CAR group(n=27)according to the optimal CAR cut-off value obtained by X-tile software.The baseline indicators and survival states between the two groups were collected.The Cox regression analysis and Kaplan-Meier method were used to assess the prognostic significance of CAR in gastric MALT lymphoma.Results The optimal cut-off value of CAR was 0.05.Compared with the low-CAR group(CAR<0.05,n=66),the high-CAR group(CAR≥0.05,n=27)had more patients older than 70 years old,higher anemia rate,higher C-reactive protein andβ2-microglobulin levels,and lower albumin level(P<0.05).Multivariate Cox analysis showed that IgG was an independent predictive factor(HR=0.528,95%CI 0.304-0.915,P=0.023).The median overall survival(OS)time was longer in the low-CAR group than that in the high-CAR group(172.8 months vs 112.7 months,P=0.020).There was no significant difference in OS among different MALT-IPI score groups;the OS of patients with CAR combined with MALT-IPI score 2 was significantly worsen than patients with score 0 or 1(P<0.05).Conclusions The prognosis of patients in high CAR group was worsen.The CAR can be used as an indicator for predicting the prognosis of gastric MALT lymphoma.