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Title: [Analysis of clinical characteristics and prognostic factors in patients with non-Hodgkin lymphoma and HBV infection].
Author: Zhang L, Yuan XL, Jiang L, Yang J, Guo JM, Shi J, Lei PC, Zhang Y, Zhu ZM.
Journal: Zhonghua Xue Ye Xue Za Zhi; 2018 Jul 14; 39(7):563-568. PubMed ID: 30122015.
Abstract:
Objective: To explore the clinical characteristics and prognostic factors of the patients with non-Hodgkin's Lymphoma (NHL) complicated with HBV infection, so as to provide a basis for clinical accurate diagnosis and prognosis evaluation. Methods: The data of 313 newly diagnosed NHL patients from August 2012 to July 2016 were collected. The HBV serological markers were detected by ELISA, and HBV DNA was quantified by full automatic microparticle chemiluminescence immunoassay (≥1×10(5) copies/ml as high copy group, 1×10(3)-<1×10(5) copies/ml as low copy group). The relationship between HBV infection and prognosis was analyzed combined with the clinical features of the patients, and the HBV detection rate was compared with that of the common population (from the national HBV sero epidemiological data). Results: ①The positive rate of HBsAg in NHL patients was 12.5% (39/313), which was higher than 7.2% in the general population (χ(2)=14.596, P<0.001). HBV infection in the past (HBsAg negative but HBcAb positive) in 114 cases (36.4%), the incidence was slightly higher than that in the general population (34.1%). ②Compared HBsAg positive group with the negative group, the proportion of B cell type (87.2% vs 70.3%, P=0.027), Ann Arbor stage Ⅲ-Ⅳ(69.2% vs 34.6%, P<0.001), IPI score 3-5 (74.4% vs 50%, P=0.004), LDH level (79.5% vs 47.8%, P<0.001) and liver involvement (45.5% vs 31.7%, P=0.006) were all higher. The difference was statistically significant. ③Compared the HBV infected group (114 cases) with the non-infected group (160 cases), the difference had statistical significance in the proportion of Ann Arbor stage Ⅲ-Ⅳ (P=0.023) and IPI score 3-5 scores P=0.035). ④Compared HBV DNA positive group (30 cases) with negative group (71 cases), Ann Arbor stage Ⅲ-Ⅳ (P=0.011), IPI score 3-5 score (P=0.030), LDH level (P=0.025) and liver involvement (P<0.001) in the proportion of patients had statistical significance. The positive patients were divided into HBV DNA high and low copy groups with 1×10(5) copies of /ml as the boundary. The results showed that there was no statistical difference between the two groups (P>0.05). Conclusions: The HBV infection rate of NHL patients is significantly higher than that of the general population, and HBV infection is more closely related to B cell type NHL. Patients with HBV infection and HBV DNA positive had late Ann Arbor stage, high IPI score, high LDH level and liver involvement, and the prognosis is poor. 目的： 探讨非霍奇金淋巴瘤（NHL）合并HBV感染患者的临床特征及预后相关因素，为临床精准诊治和预后评估提供依据。 方法： 收集2012年8月至2016年7月313例初诊NHL患者资料，采用ELISA法检测患者HBV血清学标志物，采用全自动微粒子化学发光免疫分析法定量检测HBV DNA（≥1×10(5)拷贝/ml为高拷贝组，1×10(3)~<1×10(5)拷贝/ml为低拷贝组），结合患者的临床特征，分析其HBV感染与预后的关系，并与普通人群HBV检出率（来源于全国HBV血清流行病学资料）进行对比。 结果： ①NHL患者组HBsAg阳性率为12.5%（39/313），高于普通人群的7.2%（χ(2)=14.596，P<0.001）；HBV既往感染者（HBsAg阴性但HBcAb阳性）114例（36.4%），发生率较普通人群（34.1%）略高。②HBsAg阳性组和阴性组比较，B细胞型（87.2%对70.3%，P=0.027）、Ann Arbor分期Ⅲ~Ⅳ期（69.2%对34.6%，P<0.001）、IPI评分3~5分（74.4%对50.0%，P=0.004）、LDH水平升高（79.5%对47.8%，P<0.001）、肝脏受累（45.5%对31.7%，P=0.006）患者的比例均较高，差异均有统计学意义。③HBV既往感染组（114例）与非感染组（160例）比较，Ann Arbor分期Ⅲ~Ⅳ期（P=0.023）、IPI评分3~5分（P=0.035）患者的比例组间差异均有统计学意义。④HBV DNA阳性组（30例）与阴性组（71例）比较，Ann Arbor分期Ⅲ~Ⅳ期（P=0.011）、IPI评分3~5分（P=0.03）、LDH水平升高（P=0.025）及肝脏受累（P<0.001）患者的比例组间差异均有统计学意义；以1×10(5)拷贝/ml为界将30例阳性组患者划分为HBV DNA高拷贝组（23例）和低拷贝组（7例），结果显示两组患者的上述临床特征差异无统计学意义（P值均>0.05）。 结论： NHL患者的HBV感染率明显高于普通人群，HBV感染和B细胞型NHL关系更密切；合并HBV感染、HBV DNA阳性患者Ann Arbor分期晚、IPI评分高、LDH水平高、易发生肝脏受累，其预后偏差。.

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