HBV感染的B细胞型非霍奇金淋巴瘤临床特征及预后分析

发布时间：2018-05-23 20:24

本文选题：乙肝病毒 + 非霍奇金淋巴瘤　；参考：《青岛大学》2017年硕士论文

【摘要】：目的探讨乙肝病毒(hepatitis B virus,HBV)感染与B细胞型非霍奇金淋巴瘤(B cell Non-Hodgkin's Lymphoma,B-NHL)的关系,回顾性分析HBV感染B-NHL患者的临床特征及治疗相关等预后因素。方法收集青岛市三家三级甲等医院共345例初发B-NHL患者的临床资料,分为HBsAg阳性组65例和HBsAg阴性组280例,对照全国一般人群,比较B-NHL患者与全国一般人群HBV感染率(7.2%)的差异,并对两组患者的临床特征、预后进行分析,同时,将HBsAg阳性组按治疗方案进一步分为R-CHOP和CHOP两个亚组,对两个亚组之间进行生存分析。结果(1)345例B-NHL患者乙肝表面抗原(hepatitis B surface antigen,HBsAg)阳性率为18.8%,与全国一般人群对比,差异有统计学意义(18.9%vs 7.2%,P0.001)。(2)与HBsAg阴性组相比,HBsAg阳性组患者中位发病年龄小(48岁vs 58岁,P0.01)、更易累及肝、脾或腹膜后淋巴结(4.3%vs 12.3%,P=0.013;18.9%vs 33.8%,P=0.009;35.4%vs 56.9%,P=0.001)、疾病分期晚(III/IV期44.6%vs 66.2%,P=0.002)、且预后较差(2年总生存率49.2%vs 71.3%,p0.001)。(3)单因素分析显示HBsAg阳性B-cell NHL患者预后的不良因素包括:B症状、Ann Arbor分期(III/IV期)、β2微球蛋白、未联合利妥昔单抗、未联合放疗。多因素分析显示,B症状、Ann Arbor分期(III/IV期)、未联合利妥昔单抗仍与预后差有关。(4)65例HBsAg阳性B-NHL中35例应用R-CHOP方案,其中无一例病人发生爆发性肝炎,无HBV再激活相关死亡率,30例应用CHOP方案,R-CHOP组CR+PR率高(71.4%vs 46.7%,P=0.042),与CHOP组相比,联合利妥昔单抗化疗可提高患者总体生存时间和无进展生存时间(P0.001)。在280例HBsAg阴性患者中,观察到有4例(HBsAg阴性/HBcAb阳性)HBsAg转阳,4例病人均应用R-CHOP化疗方案。结论B-NHL患者HBV感染率明显高于普通人群,HBV感染的B-NHL临床表现较独特,并且预后相对较差。利妥昔单抗可增加此类患者HBV再激活的风险,但可改善HBsAg阳性组患者预后。
[Abstract]:Objective to investigate the relationship between hepatitis B virus (HBV) infection and B cell type non Hodgkin's lymphoma (B cell Non-Hodgkin's ymphoma B NHL), and to analyze retrospectively the clinical features and prognostic factors associated with HBV infection with B-NHL. Methods the clinical data of 345 patients with primary B-NHL in three Grade 3A hospitals in Qingdao were collected and divided into HBsAg positive group (65 cases) and HBsAg negative group (280 cases). The difference of HBV infection rate between B-NHL patients and the general population was compared. The clinical characteristics and prognosis of the two groups were analyzed. Meanwhile, the HBsAg positive group was further divided into two subgroups, R-CHOP and CHOP, and survival analysis was carried out between the two subgroups. Results the positive rate of hepatitis B surface antigen-HBsAg in 345 patients with B-NHL was 18.80.Compared with the general population in China, the difference was statistically significant (18.9 vs 7.2P 0.001g. 2) compared with the negative group, the median age of B-NHL positive patients was 48 years old vs 58 years old P0.01a, which was more prone to liver involvement. Splenic or retroperitoneal lymph nodes 4.3s vs 12.3P0.013P 18.9, including P0.00935.4 vs 56.9 P0.001, 44.6%vs 66.2P 0.002 in the late stage of the disease, and poor prognosis (2-year overall survival rate 49.2%vs 71.3p0.0010.31) univariate analysis showed that adverse factors in the prognosis of HBsAg positive B-cell NHL patients included B / Ann Arbor stage IIIIV, 尾 2 microglobulin, 尾 2 microglobulin, and 尾 2 microglobulin in the patients with HBsAg positive B-cell NHL in the late stage of stage IIIIV, 尾 2 microglobulin (尾 2 microglobulin, 尾 2 microglobulin). No combination of rituximab and radiotherapy. Multivariate analysis showed that Ann Arbor stage III / IV and no Rituximab were still associated with poor prognosis in 35 of 65 patients with HBsAg positive B-NHL, none of whom developed fulminant hepatitis. Thirty patients with no HBV reactivation associated mortality were treated with CHOP regimen R-CHOP. The CR PR rate in the R-CHOP group was 71.4% vs 46.7%. Compared with the CHOP group, the combination of rituximab chemotherapy could improve the overall survival time and progression free survival time (P 0.001). Of the 280 patients with HBsAg negative, 4 patients were treated with R-CHOP regimen. Conclusion the HBV infection rate in patients with B-NHL is significantly higher than that in the general population. The clinical manifestations of HBV infection in patients with B-NHL are unique, and the prognosis is relatively poor. Rituximab increased the risk of HBV reactivation in such patients, but improved the prognosis of HBsAg positive patients.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.1;R512.62

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