侵袭性非霍奇金淋巴瘤患者化疗后感染的临床免疫因素分析

顾俊; 孙慧平; 陆弘逾; 张静芳; 赵旭鸿; 赵迪; 邓晓刚; 陈梅

doi:10.13201/j.issn.1004-2806.2015.09.011

侵袭性非霍奇金淋巴瘤患者化疗后感染的临床免疫因素分析

- 1 同济大学附属杨浦医院(上海, 200090);
- 2 上海交通大学医学院附属瑞金医院
基金项目:
上海市卫生和计划生育委员会委级科研项目(No:20134443)

详细信息

通讯作者: 陈梅,E-mail:gujun004@hotmail.com

中图分类号: R733.4

收稿日期: 2015-03-02

Analysis of immune factors influencing the infection after chemotherapy in patients with aggressive non-Hodgkin’s lymphoma

- 1 Department of Hematology, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200090, China;
- 2 Ruijin Hospital, Shanghai Jiaotong University School of Medicine

More Information

Corresponding author: CHEN Mei, E-mail: gujun004@hotmail.com

Received Date: 02 March 2015

摘要

摘要: 目的:探讨侵袭性非霍奇金淋巴瘤(NHL)患者化疗后感染的临床免疫影响因素。方法:选取2008-01-2013-12接受CHOP样方案化疗的98例侵袭性NHL患者,于化疗前检测T淋巴细胞亚群,NK细胞,免疫球蛋白(IgG,IgA,IgM)及补体(C3,C4),调查化疗后(31 d内)感染情况。通过单因素与多因素分析了解化疗后感染与临床免疫因素等的关系。结果:98例患者中发生感染29例,占29.6%。感染部位主要为呼吸道,感染程度以CTCAE 3级最多见,病原菌以革兰氏阴性菌为主。单因素分析显示,感染者化疗前CD4⁺T细胞计数,CD8⁺T细胞计数,以及IgM均显著小于未感染者[(0.24±0.14)×10⁹/L∶(0.44±0.21)×10⁹/L,(0.29±0.20)×10⁹/L∶(0.43±0.20)×10⁹/L,0.50 g/L∶0.70 g/L,P<0.05]。二元Logistic回归分析显示,化疗前CD4⁺T细胞计数与化疗后感染有关(P=0.002,OR 0.001,95%CI 0.000~0.060)。结论:化疗前CD4⁺T细胞计数是侵袭性NHL患者化疗后感染的重要影响因素,CD4⁺T细胞计数越低,化疗后感染风险越大。
- 淋巴瘤,非霍奇金 /
- 化疗 /
- 感染 /
- 免疫 /
- CD4⁺T淋巴细胞
Abstract: Objective:To investigate immune factors influencing the infection after chemotherapy in patients with aggressive non-Hodgkin's lymphoma (NHL).Method:T-lymphocyte subsets,NK cells,immunoglobulin (IgG,IgA,IgM),and complement (C3,C4) were quantified before chemotherapy (day 0) in 98 patients with aggressive NHL treated with CHOP-like chemotherapy from January 2008 to December 2013.Correlations between immune factors,clinical characteristics,and the risk of infection within 31 days after chemotherapy were investigated in univariate and multivariate analyses.Result:The infectious episode occurred in 29 of 98 patients (29.6%).The most common infective site was respiratory tract (17/29).CTCAE Grade 3 was the main severity of infection.The majority of pathogens were Gram-negative bacteria.CD4⁺T cells before chemotherapy in infective cases were significantly less than those of uninfected cases in univariate analyses [(0.24±0.14)×10⁹/L vs (0.44±0.21)×10⁹/L,(0.29±0.20)×10⁹/L vs (0.43±0.20)×10⁹/L,0.50 g/L vs 0.70 g/L,P<0.05].Binary logistic regression analysis revealed CD4⁺T cell count before chemotherapy was associated with the infection risk after chemotherapy (P=0.002,OR 0.001,95%CI 0.000-0.060).Conclusion:CD4⁺T cell count before chemotherapy is an important factor for infection after chemotherapy in patients with aggressive NHL.The lower the CD4⁺T cell count is,the greater risk of infection after chemotherapy.
- non-Hodgkin’s lymphoma /
- chemotherapy /
- infection /
- immunity /
- CD4-positive T-lymphocytes

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参考文献(7)

[1]	Alonso JJ,Canovas A,Barreiro JG,et al.Infectious complications of chemotherapy in clinically aggressive mature B and T cell lymphomas[J].Eur J Intern Med,2012,23:255-260.
[2]	王彦艳,张晋林,王椿.CTOP与CHOP方案治疗初治侵袭性非霍奇金淋巴瘤患者疗效分析[J].中华血液学杂志,2010,31(10):649-653.
[3]	张之南,沈悌.血液病诊断及疗效标准[M].3版.北京:科学出版社,2007:224-225.
[4]	Pettengell R,Bosly A,Szucs TD,et al.Multivariate analysis of febrile neutropenia occurrence in patients with non-Hodgkin lymphoma:data from the INC-EU Prospective Observational European Neutropenia Study[J].Br J Haematol,2009,144:677-685.
[5]	钱素英,方治,陈亚敏.非霍奇金淋巴瘤患者合并医院感染的临床分析[J].中华临床感染病杂志,2008,1(4):219-221.
[6]	李梦东,王宇明.实用传染病学[M].3版.北京:人民卫生出版社,2004:74-75.
[7]	周光炎.免疫学原理[M].3版.北京:科学出版社,2013:296-315.