Clinical features and prognosis of biological 25(OH) D in patients with diffuse large B-cell lymphoma
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摘要: 目的 探讨可利用生物25-羟维生素D[25(OH)D]水平与弥漫性大B细胞淋巴瘤(DLBCL)患者临床特征及预后的关系。方法 收集2017年3月至2019年5月收治的诊断为DLBCL患者124例作为DLBCL组，另选择同时期进行健康体检且结果正常者39例作为对照组。检测2组25(OH)D水平，分析患者一般临床资料和相关实验室检测指标，分析25(OH)D水平与患者临床病理特征，Kaplan-Meier分析法分析25(OH)D水平与患者累积生存时间的关系，Cox比例风险回归模型分析患者预后的独立危险因素。结果 DLBCL组患者25(OH)D水平明显低于对照组; 25(OH)D水平与DLBCL患者年龄、肿瘤分期、乳酸脱氢酶、肝功能、靶器官受损和B症状有关; 25(OH)D水平 < 18.36 ng/mL的累积生存时间明显小于25(OH)D水平≥18.36 ng/mL的患者(P< 0.05);Cox分析发现Ann Arbor分期、25(OH)D和年龄是DLBCL患者预后的独立危险因素。结论 DLBCL患者体内25(OH)D水平明显低于对照组，25(OH)D水平与患者临床病理特征具有一定的相关性，并且是患者预后的独立危险因素，值得临床关注。
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关键词:
- 25-羟维生素D /
- 弥漫性大B细胞淋巴瘤 /
- 临床特征 /
- 预后
Abstract: Objection To investigate the relationship between available biological 25(OH) D level and clinical characteristics and prognosis of patients with newly diagnosed diffuse large B-cell lymphoma(DLBCL).Methods A total of 124 patients with newly diagnosed DLBCL treated in our hospital from March 2017 to May 2019 were collected as DLBCL group. A total of 39 patients with normal physical examination results in our hospital at the same time were selected as the control group. 25(OH) D levels were detected in both groups. The general clinical data and related laboratory test indexes of patients were analyzed. The relationship between 25(OH) D level and clinicopathological characteristics was analyzed. Kaplan-Meier analysis was used to analyze the relationship between 25(OH) D level and cumulative survival time. Cox proportional hazards regression model was used to analyze the independent risk factors of prognosis.Results The level of 25(OH) D in DLBCL group was significantly lower than that in healthy control group. The level of 25(OH) D was related to age, tumor stage, lactate dehydrogenase, liver function, target organ damage and B symptoms in patients with DLBCL. The cumulative survival time of patients with 25(OH) D level < 18.36 ng/mL was significantly shorter than that of patients with 25(OH) D level ≥18.36 ng/mL(P< 0.05). Cox analysis showed that Ann Arbor stage, 25(OH) D and age were independent risk factors for the prognosis of DLBCL patients.Conclusion The level of 25(OH) D in patients with DLBCL was significantly lower than that in healthy controls. The level of 25(OH) D had a certain correlation with the clinicopathological features of patients. It may be an independent risk factor for the prognosis of patients, which should deserve clinical attention.-
Key words:
- 25(OH) D /
- diffuse large B-cell lymphoma /
- clinical features /
- prognosis
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表 1 25(OH)D水平与DLBCL患者临床特征比较
X±S 临床特征 例数 25(OH)D/(ng·mL-1) t P 临床特征 例数 25(OH)D/(ng·mL-1) t P 性别 0.209 0.731 肿瘤起源 0.061 0.827 男 66 20.23±8.96 GCB 49 19.04±10.26 女 58 19.74±10.21 non-GCB 75 19.87±10.13 年龄 3.216 0.036 LDH 3.145 0.028 ≥65岁 64 18.46±9.85 正常 55 21.06±10.46 < 65岁 60 20.76±10.79 升高 69 17.22±10.03 Ann Arbor分期 3.517 0.029 肝功能 3.214 0.024 Ⅰ~Ⅱ 73 21.18±10.24 正常 87 20.98±9.15 Ⅲ~Ⅳ 51 17.84±9.13 异常 37 17.69±9.67 IPI分期 3.026 0.038 靶器官受损 3.462 0.031 低危 71 21.39±10.14 有 43 16.97±10.11 中危 24 18.52±9.86 无 81 19.82±9.34 高危 29 17.24±10.17 B症状 3.724 0.042 是 46 17.74±9.89 否 78 20.05±10.06 
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表 2 25(OH)D水平与DLBCL患者疗效的关系
例(%) 25(OH)D CR PR SD PD χ2 P ≥18.36 ng/mL 7(70.0) 17(36.2) 14(27.5) 3(18.8) 11.463 < 0.001 < 18.36 ng/mL 3(30.0) 30(63.8) 37(72.5) 13(81.3)
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表 3 预后相关因素分析
因素 B SE χ2 P RR 95%CI Ann Arbor分期 0.375 0.509 6.824 0.028 1.367 1.414~5.086 25(OH)D 0.404 0.720 9.713 0.032 1.429 1.396~6.417 年龄 0.483 0.664 8.326 0.024 1.033 1.372~8.508 靶器官受损 0.732 0.493 6.544 0.075 1.121 1.421~6.709
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