文章摘要
周晓慧,王 莉,朱华渊,李建勇,徐 卫.外周血CD4+ T淋巴细胞绝对数及CD4+/CD8+比值在套细胞淋巴瘤中的预后价值[J].南京医科大学学报,2019,(4):520~527
外周血CD4+ T淋巴细胞绝对数及CD4+/CD8+比值在套细胞淋巴瘤中的预后价值
Prognostic value of absolute CD4+ T cell counts and CD4+/CD8+ ratio in peripheral blood of patients with mantle cell lymphoma
投稿时间:2018-09-20  
DOI:10.7655/NYDXBNS20190410
中文关键词: 套细胞淋巴瘤  CD4+T淋巴细胞绝对数  CD4+/CD8+比值  预后
英文关键词: mantle cell lymphoma  absolute CD4+ T cell count  CD4+/CD8+ ratio  prognosis
基金项目:国家自然科学基金(81770166,81370657)
作者单位
周晓慧 南京医科大学第一附属医院血液科江苏 南京 210029 
王 莉 南京医科大学第一附属医院血液科江苏 南京 210029 
朱华渊 南京医科大学第一附属医院血液科江苏 南京 210029 
李建勇 南京医科大学第一附属医院血液科江苏 南京 210029 
徐 卫 南京医科大学第一附属医院血液科江苏 南京 210029 
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中文摘要:
      目的:探索外周血T淋巴细胞亚群计数在套细胞淋巴瘤(mantle cell lymphoma,MCL)患者中的分布、与临床特征的相关性及预后价值。方法:回顾性分析2006—2017年92例初诊MCL患者的临床资料。使用简化的MCL国际预后指数(sMIPI)进行预后评分,采用流式细胞术分析T淋巴细胞亚群计数,包括CD4+ T淋巴细胞绝对数(ACD4C)和CD8+ T淋巴细胞绝对数(ACD8C)。Mann?Whitney U及Kruskal?Wallis检验分析T淋巴细胞亚群计数与其他临床指标的相关性。采用 Kaplan?Meier 法进行生存分析,Cox比例风险模型进行预后因素分析。结果:中位随访51个月(12~150个月),92例患者的中位总生存期(OS)是44个月。1年、3年、5年OS率分别为72%、45%、37%。ACD4C >0.5×109个/L的患者较ACD4C ≤0.5×109个/L的患者的无进展生存期(PFS)和OS更长(P=0.009和P=0.004)。CD4+/CD8+比值>1.2的患者较≤1.2的患者有更长的PFS和OS(P=0.025和 P=0.009)。单变量Cox回归分析显示:体力状态(ECOG评分)≥2分(P=0.021)、B症状(发热、盗汗或体重下降)(P=0.001)、升高的血清乳酸脱氢酶(LDH)(P=0.027)、高sMIPI评分(P=0.004)、低ACD4C(P=0.013)、低CD4+/CD8+比值(P=0.030)与较短的PFS相关。而较短的OS与B症状(P < 0.001)、高sMIPI评分(P=0.004)、升高的LDH(P=0.040)、低ACD4C(P=0.006)和低CD4+/CD8+比值(P=0.012)相关。多因素Cox回归分析显示:B症状(P=0.006)、低ACD4C(P=0.001)是影响PFS的独立预后因素;B症状(P=0.003)、高sMIPI评分(P=0.047)、低ACD4C(P=0.001)、低CD4+/CD8+比值(P=0.031)是影响OS独立的预后因素。结论:低ACD4C、低CD4+/CD8+比值与MCL患者不良的预后相关,ACD4C水平、CD4+/CD8+比值可作为判断MCL患者预后方便且有效的指标。
英文摘要:
      Objective: To explore the distribution of T lymphocyte subsets in peripheral blood of patients with mantle cell lymphoma(MCL),and evaluate correlation with clinical baseline characteristics and its prognostic value. Methods:The clinical data of 92 newly diagnosed MCL patients from 2006 to 2017 were analyzed retrospectively. The prognostic stratification was performed using a simplified MCL international prognostic index sMIPI. The T lymphocyte subsets,including the absolute number of CD4+ T lymphocytes(ACD4C)and the absolute number of CD8+ T lymphocytes(ACD8C)were analyzed by flow cytometry. Comparisons of T lymphocyte subsets as continuous parameters in different groups were described using Mann?Whitney U test and Kruskal?Wallis. Kaplan?Meier method was used to survival analysis,and the Cox proportional hazards models were used for the estimation of prognostic factors. Results:The median follow?up was 51 months(12?150 months),and the median overall survival(OS)in 92 patients was 44 months. The OS rate at 1,3 and 5 years was 72%,45% and 37%,respectively. In our cohort,patients with high ACD4C(>0.5×109/L)had longer PFS and OS(P=0.009,P=0.004),while patients with low CD4+/CD8+ ratio(≤1.2)had unfavorable PFS and OS(P=0.025,P=0.009). Univariate Cox regression indicated that ECOG ≥2(P=0.021),B symptoms(fever,night sweats or weight loss)(P=0.001),elevated LDH(P=0.027),high sMIPI score(P=0.004),low ACD4C(P=0.013)and low CD4+/CD8+ ratio(P=0.030)correlated with shorter PFS,while the inferior OS was associated with B symptoms(P<0.001),high sMIPI score(P=0.004),elevated LDH(P=0.040),low ACD4C(P=0.006)and low CD4-/CD8+ ratio(P=0.012). Multivariate Cox regression showed that B symptoms(P=0.006)and low ACD4C(P=0.001)were the independent prognostic factors of PFS;B symptoms(P=0.003),high sMIPI score(P=0.047),low ACD4C(P=0.001),low CD4+/CD8+ ratio(P=0.031)were the independent prognostic factors of OS. Conclusion:Low ACD4C and low CD4+/CD8+ ratio were associated with unfavorable prognosis in MCL patients. ACD4C level and CD4+/CD8+ ratio proved to be convenient and effective predictors of prognosis in patients with MCL.
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