累及心脏的非霍奇金淋巴瘤临床特征及预后危险因素分析

祖丽胡玛尔· 艾斯卡尔; 周迪; 陈悦; 彭苗新; 许景艳; 杨永公; 周荣富; 欧阳建; 陈兵; 许佩佩

doi:10.13201/j.issn.1004-2806.2023.03.008

累及心脏的非霍奇金淋巴瘤临床特征及预后危险因素分析

- 1.
  南京大学医学院附属鼓楼医院血液科(南京，210008)
- 2.
  江苏大学鼓楼临床医学院

详细信息

通讯作者: 许佩佩，E-mail：xu_peipei0618@163.com

中图分类号: R733.4

收稿日期: 2022-06-25

刊出日期: 2023-03-01

Clinical characteristics and prognosis risk factors of non-Hodgkin's lymphoma involving the heart

- 1.
  Department of Hematology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
- 2.
  Nanjing Drum Tower Hospital Clinical College of Jiangsu University

More Information

Corresponding author: XU Peipei, E-mail: xu_peipei0618@163.com

Received Date: 25 June 2022

Publish Date: 01 March 2023

摘要

摘要: 目的分析累及心脏的非霍奇金淋巴瘤(NHL)的临床特征及预后危险因素，评估不同治疗方案对患者预后的影响。方法回顾性分析南京鼓楼医院血液科诊治的66例累及心脏的NHL患者的临床资料，结合随访资料进行统计学分析。结果累及心脏的NHL以B细胞淋巴瘤为主(95.24%)。患者接受手术治疗5例，化疗40例，化疗联合放疗/手术治疗21例，中位总生存期为9个月，中位无进展生存期为7个月，中位随访时间31个月，利妥昔单抗治疗组、应用脂质体阿霉素组的中位生存期明显延长(P < 0.05)。性别、IPI评分、心脏外累及病灶、心电图异常、乳酸脱氢酶水平、β₂微球蛋白水平对预后有显著影响；其中IPI评分、心电图异常是影响患者生存的独立危险因素(P < 0.05)。结论含利妥昔单抗及脂质体阿霉素的化疗方案为累及心脏的NHL患者治疗首选，但该病总体预后差，需尽早发现、尽早诊断以提高患者生存率。
- 累及心脏的非霍奇金淋巴瘤 /
- 临床特征 /
- 预后 /
- 危险因素
Abstract: Objective To summarize the clinical characteristics and risk factors of non-Hodgkin's lymphoma involving the heart, and evaluate the impact of different treatment options on prognosis.Methods Sixty-six patients with non-Hodgkin's lymphoma involving the heart diagnosed in the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School were included. Clinical and follow-up data were analyzed retrospectively.Results B cell lymphoma accounted for 95.24% of NHL involving the heart. Sixty-six NHL patients with heart involvement, 5 received surgical treatment alone, 40 received chemotherapy alone and 21 received chemotherapy combined with radiotherapy/surgical treatment. Median OS was 9 months and median PFS was 7 months. The median follow-up time was 31 months. The median OS of patients receiving Rituximab or liposomal doxorubicin was significantly longer(P < 0.05). The sex, IPI score, multisystem involvement, ECG abnormalities, LDH level, serum β2-microglobulin level were relevant factors affecting prognosis(P < 0.05). IPI score and arrhythmia were independent risk factors affecting PFS and OS(P < 0.05).Conclusion Chemo-regimen including rituximab or liposomal doxorubicin is the first-line therapy for patients with NHL involving the heart, but its overall prognosis is poor. Timely diagnosis is necessary to improve patients' clinical outcome.
- non-Hodgkin's lymphoma involving the heart /
- clinical characteristics /
- prognosis /
- risk factors

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图 1 患者1行¹⁸F-FDG PET/CT检查

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图 2 患者2行¹⁸F-FDG PET/CT检查

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图 3 原发性、继发性与对照患者的OS、PFS生存曲线

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图 4 不同治疗方案PFS、OS生存曲线

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表 1 患者基本临床特征例(%)

特点	总例数(66例)
年龄/岁	61(21~83)
性别
男	41(62.1)
女	25(37.9)
分类
B细胞淋巴瘤	63(95.5)
DLBCL	57(86.4)
小淋巴细胞淋巴瘤	2(3.0)
套细胞淋巴瘤	1(1.5)
滤泡性淋巴瘤	1(1.5)
Burkitt淋巴瘤	2(3.0)
NK/T细胞淋巴瘤	3(4.5)
B症状
有	33(50.0)
无	33(50.0)
血清LDH
正常	37(56.1)
升高	29(43.9)
血清β2微球蛋白
正常	37(56.1)
升高	29(43.9)
IPI评分
1~3	32(48.5)
4~5	34(51.5)

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表 2 单系统与多系统累及患者的临床特征比较例(%)

项目	分组	单系统组(35例)	多系统组(31例)	χ²	P
性别	男	18(51.4)	23(74.2)	3.55	0.060
年龄	≥60岁	17(48.6)	20(64.5)	0.49	0.490
IPI评分	4~5分	10(28.6)	24(77.4)	17.93	＜0.001
临床症状	心血管系统症状	30(85.7)	26(83.9)	0.08	0.780
	B症状	13(37.1)	20(64.5)	5.93	0.015
细胞来源	B细胞	34(97.1)	29(93.5)	0.54	0.460
	NK/T细胞	0	3(9.7)
感染病毒	HBV阳性	3(8.6)	6(19.4)	1.80	0.180
	EBV DNA增高	1(2.9)	7(22.6)	16.34	0.012
辅助检查	心包积液	21(60.0)	17(54.8)	0.32	0.572
	心电图异常	25(71.4)	18(58.1)	0.28	0.596
	LDH升高	11(31.4)	18(58.1)	5.45	0.020
	心肌酶异常	17(48.6)	11(35.5)	0.53	0.470
	Hb下降	9(25.7)	18(58.1)	8.05	0.005
	β2微球蛋白升高	13(37.1)	16(51.6)	0.64	0.420

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表 3 预后指标单因素分析

项目	分组	例(%)	PFS分析				OS分析
			中位PFS/月	95%CI	log-rank		中位OS/月	95%CI	log-rank
			中位PFS/月	95%CI	χ²	P	中位OS/月	95%CI	χ²	P
性别	男	41(62.1)	9	7.62~10.38	4.54	0.033	10	7.32~12.68	4.03	0.045
	女	25(37.9)	5	3.66~6.34			6	4.57~7.43
年龄	≥60岁	37(56.1)	9	6.03~11.97	0.43	0.514	10	4.90~15.10	0.25	0.642
	< 60岁	29(43.9)	7	4.82~9.18			9	7.65~10.36
心电图异常	有	43(65.2)	9	7.81~10.20	2.62	0.106	11	8.02~13.98	8.35	0.004
	无	23(34.8)	7	5.08~8.92			8	4.83~11.74
IPI评分	1~3	32(48.5)	10	7.49~12.51	7.80	0.005	12	8.26~15.74	10.27	0.001
	4~5	34(51.5)	5	3.18~6.82			6	4.06~7.94
心包积液	有	38(57.6)	6	3.62~8.38	0.83	0.364	7	2.28~11.72	0.22	0.641
	无	28(42.4)	9	6.57~11.43			11	8.06~11.94
β2微球蛋白	升高	29(43.9)	6	2.88~9.12	4.69	0.030	11	6.67~15.33	6.88	0.009
	正常	37(56.1)	9	6.02~11.97			7	3.51~10.49
心肌酶	异常	28(42.4)	6	4.32~7.68	2.51	0.113	7	3.81~10.18	1.56	0.212
	正常	38(57.6)	10	7.90~12.10			11	7.86~14.14
Ki-67	≥50%	33(50.0)	5	3.13~6.87	0.13	0.715	7	4.29~9.72	0.52	0.470
	< 50%	33(50.0)	6	4.47~7.53			11	8.27~13.74
心外累及	有	31(47.0)	6	3.47~8.53	0.54	0.463	7	4.41~9.59	4.91	0.027
	无	35(53.0)	9	6.23~11.78			11	7.44~14.56
LDH	升高	29(43.9)	9	4.47~13.53	6.87	0.009	13	9.49~16.52	9.16	0.002
	正常	37(56.1)	6	3.42~8.59			6	3.07~8.93

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表 4 应用各类方案后患者的生存分析

分类	例数(%)	总有效率/%	χ²	P
治疗方案
手术	5(7.6)	0	17.07	< 0.001
化疗	40(60.6)	87.5
化疗联合手术/放疗	21(31.8)	90.4
是否应用利妥昔单抗
未用利妥昔单抗组	11(16.7)	81.8	6.68	0.010
应用利妥昔单抗组	50(75.8)	90.0
是否脂质体阿霉素
应用脂质体阿霉素组	29(43.9)	93.1	3.92	0.048
未应用脂质体阿霉组	32(48.5)	84.3

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表 5 应用化疗方案后患者的中位生存时间

分类	例数(%)	中位OS/月	χ²	P
是否应用利妥昔单抗
未用利妥昔单抗组	11(16.67)	9	8.49	0.004
应用利妥昔单抗组	50(75.76)	10
是否应用脂质体阿霉素
应用脂质体阿霉素组	29(43.94)	12	11.45	0.005
未应用脂质体阿霉组	32(48.48)	5

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表 6 PFS、OS多因素回归分析

项目	PFS		OS
项目	Exp β(95%CI)	P	Exp β(95%CI)	P
IPI评分	3.17(1.67~6.01)	< 0.001	4.00(2.02~7.93)	< 0.001
心电图异常	1.85(1.03~3.31)	0.040	1.88(1.05~3.38)	0.035

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