艾滋病相关弥漫大B细胞淋巴瘤患者临床实验室检查指标特征分析

Characteristics of clinical parameters in patients with diffuse large B-cell lymphoma associated with chromic HIV infection

目的对艾滋病相关弥漫大B细胞淋巴瘤(diffuse large B-cell lymphom,DLBCL)患者的临床实验室特征进行分析,为临床诊治提供依据。方法回顾性分析云南省传染病医院2017年1月至2022年12月期间确诊为艾滋病相关DLBCL患者不同临床分期、国际预后指数(international prognostic index,IPI)评分和病理亚型等临床相关实验室指标。根据D-二聚体(D-dimer,D-D)和纤维蛋白原(fibrinogen,FIB)水平进行分组,对不同D-D和FIB水平组进行生存分析,同时分析存活组与死亡组化疗前后D-D和FIB水平变化。结果70例艾滋病相关DLBCL患者中男性占77.1%;5年生存率为60.0%,存活组的平均生存时间远高于死亡组(P<0.05)。Ann Arbor临床分期Ⅰ、Ⅱ期患者的D-D、红细胞分布宽度(red blood cell distribution width,RDW)均低于III、IV期患者,血红蛋白(hemoglobin,HGB)、白蛋白(albumin,ALB)水平均高于III、IV期患者(P均<0.05);在IPI评分中,IPI为4~5分患者的FIB和D-D水平均高于IPI为0~3分患者,而IPI为4~5分患者的HGB和ALB水平均低于IPI为0~3分患者(P均<0.05)。血浆高水平FIB和D-D组的患者与低水平组的5年无进展生存期并无显著差异(P>0.05);多次化疗后,2组患者血浆FIB水平相对稳定,而生存组D-D水平从第2次化疗后有下降趋势(P<0.05)。结论在艾滋病相关DLBCL患者诊断初期,可以由实验室常规检测指标推测患者临床状态。

Objective To analyze the clinical laboratory characteristics of AIDS-related diffuse large B-cell lymphom(DLBCL)patients,so as to provide reference for clinical treatment.Methods Clinical stage,IPI score and pathological subtype of patients diagnosed with AIDS-related diffuse large B-cell lymphoma in our hospital from January 2017 to December 2022 were retrospectively analyzed.Grouped according to different D-dimer(D-D)and Fibrinogen(FIB)levels,and the survival curves of risk were compared in two groups by Log-rank test.Then,compared the levels of D-D and FIB before and after chemotherapy in the survival group and the death group.Results Among the 70 AIDS-related DLBCL patients,males accounted for 77.1%,with a 5-year survival rate of 60.0%.The average survival time of the survivors was significantly longer than that of the deceased(P<0.05),being about three times that of the deceased.In the Ann Arbor clinical staging,the D-D and RDW of patients in stages I and II were lower than those in stages III and IV,while the HGB and ALB of patients in stages I and II were higher than those in stages III and IV(P<0.05);in the IPI scoring system,the FIB and D-D levels of patients with IPI scores of 4-5 were higher than those of patients with IPI scores of 0-3,while the HGB and ALB levels of patients with IPI scores of 4-5 were lower than those of patients with IPI scores of 0-3(P<0.05).There was no significant difference in the 5-year PFS between patients with high FIB and D-D plasma levels and those with low levels(P>0.05);after multiple chemotherapies,the FIB content in the plasma of both groups stabilized,while the D-D content in the survivors’plasma showed a downward trend after the second chemotherapy,with a statistically significant difference(P<0.05).Conclusion The clinical status of patients with HIV/AIDS-related diffuse large B-cell lymphoma can be predicted by routine laboratory tests at the early stage of diagnosis.