霍奇金淋巴瘤患者中EB病毒感染状态及预后分析
发布时间：2019-02-15 21:10
【摘要】：目的：霍奇金淋巴瘤与EB病毒(Epstein-Barr virus EBV)感染密切相关,不同地区、人种间EBV感染率不同；本文为评估我院近7年收治霍奇金淋巴瘤患者中EBV感染状态检测情况,并将EBV感染对患者治疗及预后的影响进行了回顾性分析。方法：按照WHO淋巴瘤分类标准,对我院2008.2至2014.10收治的全部霍奇金淋巴瘤进行筛选,筛选出通过原位杂交方法检测蜡块中EBV编码的RNA(Epstein-Barr Virus Encoded RNA,EBER)或通过免疫组化方法检测蜡块中潜伏膜蛋白-1(Latent membrane protein-1, LMP-1)表达确定EBV感染状态的207例初治霍奇金淋巴瘤患者,收集基本信息、治疗方法、疗效及生存信息,对信息进行回顾性分析与总结,统计EBV阳性率,分析EBV感染状态与疾病状态的相关性及对患者预后的影响；分析儿童、老年霍奇金淋巴瘤临床特征及EBV感染特征。结果：2008年2月至2014年10月共收治霍奇金淋巴瘤329例,筛选符合条件207例。207例中191例检测了EBER,64例(33.5%)阳性；16例检测了LMP-1,2例(12.5%)阳性,总阳性率31.9%。EBV阳性患者中,男性多见(69.7%),混合细胞型为主(52.9%),多合并β2微球蛋白升高。EBV阳性发病年龄有两个高峰,分别是在儿童(年龄0-15岁)和老年(年龄60岁),EBV阳性率分别为47.4%和71.4%；在16-60岁成人患者,EBV阳性率随年龄的增加而升高。不同地域间比较,西部地区患者中EBV阳性率高于东部、东北部及中部地区患者(45.5%比30.6%、26.8%、28.0%,P0.05)。单因素分析结果提示,EBV阳性患者的总生存时间(OS)短于EBV阴性组,无进展生存时间(PFS)无统计学差异；年龄60岁老年患者OS和PFS均短于0-15岁和16-60岁组；血清白蛋白40g/L患者OS和PFS均短于对照组；早期患者中,接受放疗治疗可延长PFS,但对OS无影响。多因素预后分析模型提示EBV阳性是总生存时间的不良预后因素。儿童患者(0-15岁组)HL19例,中位年龄12岁,EBV阳性率为47.4%,0-9岁组和10-15岁组EBV阳性分别为66.7%和38.5%；治疗模式多为化放疗联合治疗,中位随访35个月,全组患者长期生存,且未出现心脏毒性等远期毒性。年龄≥60岁老年HL 16例,中位年龄65岁,EBV阳性率为75.0%,病理类型以混合细胞型为主(68.8%),接受过放疗治疗患者OS较未接受过放疗治疗组长(P=0.078)。结论：EBV感染与霍奇金淋巴瘤存在一定相关性,本中心207例初治霍奇金淋巴瘤患者中EBV阳性检测率31.9%,病理类型以混合细胞型为主,且儿童及老年患者中多见；在不同地域间,西部患者EBV阳性率高于其他地区。和EBV阴性患者相比,EBV阳性患者总生存时间短。
[Abstract]:Objective: Hodgkin's lymphoma is closely related to EB virus (Epstein-Barr virus EBV) infection), and EBV infection rate is different in different regions and ethnic groups. In order to evaluate the status of EBV infection in patients with Hodgkin's lymphoma treated in our hospital in recent 7 years, the influence of EBV infection on the treatment and prognosis of patients was analyzed retrospectively. Methods: according to the classification criteria of WHO lymphoma, all Hodgkin's lymphomas treated in our hospital from 2008.2 to 2014.10 were screened, and the RNA (Epstein-Barr Virus Encoded RNA,) encoding EBV in wax was screened by in situ hybridization. EBER) or the expression of latent membrane protein-1 (1 (Latent membrane protein-1, LMP-1) in paraffin mass was detected by immunohistochemistry in 207patients with newly diagnosed Hodgkin's lymphoma. The basic information, treatment method, curative effect and survival information were collected. The information was retrospectively analyzed and summarized, the positive rate of EBV was counted, the correlation between EBV infection and disease status and the influence on the prognosis of patients were analyzed. The clinical and EBV infection characteristics of Hodgkin's lymphoma in children and elderly were analyzed. Results: from February 2008 to October 2014, 329 cases of Hodgkin's lymphoma were treated. 191 of 207 cases (33.5%) were positive for EBER,64. The positive rate of LMP-1,2 was 12.5% (16 / 16). The total positive rate of 31.9%.EBV was 69.7% (male), 52.9% (52.9%) in mixed cell type, 69.7% (69.7%) in male and 52.9% (52.9%) in mixed cell type. There were two peaks in the onset age of EBV positive in children (ages 0-15 years) and old people (age 60 years old), the positive rates of), EBV were 47.4% and 71.4%, respectively. In adults aged 16-60, the positive rate of EBV increased with age. The positive rate of EBV in the western region was higher than that in the eastern part and the northeast and central region (45.5% vs 30.626.8%, P 0.05). Univariate analysis showed that the total survival time (OS) of EBV positive patients was shorter than that of EBV negative group, and no significant difference was found in (PFS), OS and PFS were shorter in 60 years old patients than those in 0-15 years and 16-60 years groups. Both OS and PFS were shorter in patients with serum albumin 40g/L than those in control group. In early patients, radiotherapy could prolong PFS, but had no effect on OS. Multivariate prognostic analysis showed that EBV positive was a poor prognostic factor for total survival time. The median age of HL19 was 12 years old. The positive rate of EBV was 47.4% in 0-9 years group and 66.7% in 10-15 years old group. The positive rate of EBV was 38.5% in 10-15 years old group and 66.7% in 0-15 years old group. Most of the patients were treated by combined chemotherapy and radiotherapy. The median follow-up was 35 months. The patients survived for a long time, and there was no long-term toxicity such as cardiac toxicity. The median age was 65 years old. The positive rate of EBV was 75.0%. The pathological type was mainly mixed cell type (68.8%). The OS of the patients who had been treated with radiotherapy was higher than that of the patients without radiotherapy (P0. 078). Conclusion: there is a certain correlation between EBV infection and Hodgkin's lymphoma. The positive detection rate of EBV in 207 cases of newly treated Hodgkin's lymphoma is 31.9.The pathological type is mainly mixed cell type, and it is more common in children and elderly patients. The positive rate of EBV in western patients was higher than that in other regions. The total survival time of EBV positive patients was shorter than that of EBV negative patients.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R733.1
，
本文编号：2423699
[Abstract]:Objective: Hodgkin's lymphoma is closely related to EB virus (Epstein-Barr virus EBV) infection), and EBV infection rate is different in different regions and ethnic groups. In order to evaluate the status of EBV infection in patients with Hodgkin's lymphoma treated in our hospital in recent 7 years, the influence of EBV infection on the treatment and prognosis of patients was analyzed retrospectively. Methods: according to the classification criteria of WHO lymphoma, all Hodgkin's lymphomas treated in our hospital from 2008.2 to 2014.10 were screened, and the RNA (Epstein-Barr Virus Encoded RNA,) encoding EBV in wax was screened by in situ hybridization. EBER) or the expression of latent membrane protein-1 (1 (Latent membrane protein-1, LMP-1) in paraffin mass was detected by immunohistochemistry in 207patients with newly diagnosed Hodgkin's lymphoma. The basic information, treatment method, curative effect and survival information were collected. The information was retrospectively analyzed and summarized, the positive rate of EBV was counted, the correlation between EBV infection and disease status and the influence on the prognosis of patients were analyzed. The clinical and EBV infection characteristics of Hodgkin's lymphoma in children and elderly were analyzed. Results: from February 2008 to October 2014, 329 cases of Hodgkin's lymphoma were treated. 191 of 207 cases (33.5%) were positive for EBER,64. The positive rate of LMP-1,2 was 12.5% (16 / 16). The total positive rate of 31.9%.EBV was 69.7% (male), 52.9% (52.9%) in mixed cell type, 69.7% (69.7%) in male and 52.9% (52.9%) in mixed cell type. There were two peaks in the onset age of EBV positive in children (ages 0-15 years) and old people (age 60 years old), the positive rates of), EBV were 47.4% and 71.4%, respectively. In adults aged 16-60, the positive rate of EBV increased with age. The positive rate of EBV in the western region was higher than that in the eastern part and the northeast and central region (45.5% vs 30.626.8%, P 0.05). Univariate analysis showed that the total survival time (OS) of EBV positive patients was shorter than that of EBV negative group, and no significant difference was found in (PFS), OS and PFS were shorter in 60 years old patients than those in 0-15 years and 16-60 years groups. Both OS and PFS were shorter in patients with serum albumin 40g/L than those in control group. In early patients, radiotherapy could prolong PFS, but had no effect on OS. Multivariate prognostic analysis showed that EBV positive was a poor prognostic factor for total survival time. The median age of HL19 was 12 years old. The positive rate of EBV was 47.4% in 0-9 years group and 66.7% in 10-15 years old group. The positive rate of EBV was 38.5% in 10-15 years old group and 66.7% in 0-15 years old group. Most of the patients were treated by combined chemotherapy and radiotherapy. The median follow-up was 35 months. The patients survived for a long time, and there was no long-term toxicity such as cardiac toxicity. The median age was 65 years old. The positive rate of EBV was 75.0%. The pathological type was mainly mixed cell type (68.8%). The OS of the patients who had been treated with radiotherapy was higher than that of the patients without radiotherapy (P0. 078). Conclusion: there is a certain correlation between EBV infection and Hodgkin's lymphoma. The positive detection rate of EBV in 207 cases of newly treated Hodgkin's lymphoma is 31.9.The pathological type is mainly mixed cell type, and it is more common in children and elderly patients. The positive rate of EBV in western patients was higher than that in other regions. The total survival time of EBV positive patients was shorter than that of EBV negative patients.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R733.1
，
本文编号：2423699
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