LMR/LDH对弥漫大B细胞淋巴瘤合并乙型病毒性肝炎患者预后的价值

Value of LMR/LDH in the prognosis of patients with diffuse large B-cell lymphoma combined with hepatitis B virus

目的探讨外周血淋巴细胞/单核细胞比值(LMR)与乳酸脱氢酶(LDH)的比值(LMR/LDH)对弥漫大B细胞淋巴瘤(DLBCL)合并乙型病毒性肝炎患者预后的价值。方法选取DLBCL合并乙型病毒性肝炎患者77例为研究对象,收集患者的临床资料[性别、年龄、临床分期、B症状、美国东部肿瘤协作组(ECOG)评分、淋巴结外受累数量、国际预后指数(IPI)分级等];抽取治疗前空腹抗凝全血及静脉血,采用电阻抗、高频电导及激光散射联合检测法检测淋巴细胞绝对值和单核细胞绝对值并计算LMR,采用紫外分光光度法和免疫比浊法检测血清乳酸脱氢酶(LDH)和β2-微球蛋白(β2-MG);所有患者出院后随访36个月,记录患者的总生存期(OS)及无进展生存期(PFS);采用患者工作特征(ROC)曲线确定LMR/LDH的临界值,分析LMR/LDH高低对患者OS及PFS的影响;采用COX回归模型分析LMR/LDH与患者临床特征的关系。结果ROC曲线分析显示,LMR/LDH的临界值为0.008,敏感度和特异度分别为0.6607和0.7619,曲线下面积(AUC)为0.7054(95%CI为0.5491~0.8937,P=0.0057);LMR/LDH与临床分期、ECOG评分、淋巴结外受累数量、IPI、LDH、β2-MG相关(P<0.05);单因素分析显示,LMR/LDH、临床分期、ECOG≥2分、淋巴结外受累数量≥2个、IPI、LDH及β2-MG对患者OS及PFS均有影响(P<0.05);多因素分析显示,LMR/LDH是影响DLBCL合并乙型病毒性肝炎患者OS及PFS的独立危险因素(P<0.05);高LMR/LDH组的OS与PFS高于低LMR/LDH组。结论LMR/LDH对DLBCL合并乙型病毒性肝炎患者的预后有一定的临床预测价值。

Objective To investigate value of peripheral blood lymphocyte-monocyte ratio(LMR)to lactate dehydrogenase(LDH)ratio(LMR/LDH)in the prognosis of patients with diffuse large B-cell lymphoma(DLBCL)complicated with hepatitis B virus.Methods The following clinical data of 77 patients with DLBCL combined with hepatitis B virus infection were collected:gender,age,clinical stage,B symptoms,Eastern Cooperative Oncology Group(ECOG)score,number of extranodal involvement,international prognostic index(IPI)score.Fasting anticoagulated whole blood and venous blood were collected before treatment.The combined detection method of electrical impedance,high-frequency conductivity,and laser scattering were used to measure the absolute values of lymphocytes and monocytes,and LMR was calculated.Ultraviolet spectrophotometry was utilized to detect serum LDH and immunoturbidimetry was used to detectβ2-microglobulin(β2-MG).All patients were followed up for 36 months after discharge,and the overall survival(OS)and progression-free survival(PFS)were recorded.The critical value of LMR/LDH was determined by Receiver Operating Characteristic(ROC)curve,and the effect of LMR/LDH on OS and PFS was analyzed.COX regression model was used to analyze the relationship between LMR/LDH and clinical characteristics of patients.Results ROC curve analysis showed that the critical value of LMR/LDH was 0.008,the sensitivity and specificity were 0.6607 and 0.7619,respectively.The area under the curve(AUC)was 0.7054(95%CI was from 0.5491 to 0.8937,P=0.0057).LMR/LDH was significantly correlated with clinical stage,ECOG score,number of extranodal involvement,IPI,LDH and β2-MG(P<0.05).Univariate analysis showed that LMR/LDH,clinical stage,and ECOG≥2,number of extranodal involvement≥2,IPI,LDH,β2-MG had significant effects on OS and PFS of patients(P<0.05).Multivariate analysis showed that LMR/LDH was an independent risk factor affecting OS and PFS in DLBCL patients with hepatitis B virus(P<0.05).The high LMR/LDH group exhibited improved OS and PFS compared to the low LMR/LDH group.Conclusion LMR/LDH has certain clinical predictive value for the prognosis of patients with DLBCL complicated with hepatitis B virus.