發(fā)布時間：2018-05-23 20:24

  本文選題：乙肝病毒 + 非霍奇金淋巴瘤��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的探討乙肝病毒(hepatitis B virus,HBV)感染與B細胞型非霍奇金淋巴瘤(B cell Non-Hodgkin's Lymphoma,B-NHL)的關(guān)系,回顧性分析HBV感染B-NHL患者的臨床特征及治療相關(guān)等預(yù)后因素。方法收集青島市三家三級甲等醫(yī)院共345例初發(fā)B-NHL患者的臨床資料,分為HBsAg陽性組65例和HBsAg陰性組280例,對照全國一般人群,比較B-NHL患者與全國一般人群HBV感染率(7.2%)的差異,并對兩組患者的臨床特征、預(yù)后進行分析,同時,將HBsAg陽性組按治療方案進一步分為R-CHOP和CHOP兩個亞組,對兩個亞組之間進行生存分析。結(jié)果(1)345例B-NHL患者乙肝表面抗原(hepatitis B surface antigen,HBsAg)陽性率為18.8%,與全國一般人群對比,差異有統(tǒng)計學(xué)意義(18.9%vs 7.2%,P0.001)。(2)與HBsAg陰性組相比,HBsAg陽性組患者中位發(fā)病年齡小(48歲vs 58歲,P0.01)、更易累及肝、脾或腹膜后淋巴結(jié)(4.3%vs 12.3%,P=0.013;18.9%vs 33.8%,P=0.009;35.4%vs 56.9%,P=0.001)、疾病分期晚(III/IV期44.6%vs 66.2%,P=0.002)、且預(yù)后較差(2年總生存率49.2%vs 71.3%,p0.001)。(3)單因素分析顯示HBsAg陽性B-cell NHL患者預(yù)后的不良因素包括:B癥狀、Ann Arbor分期(III/IV期)、β2微球蛋白、未聯(lián)合利妥昔單抗、未聯(lián)合放療。多因素分析顯示,B癥狀、Ann Arbor分期(III/IV期)、未聯(lián)合利妥昔單抗仍與預(yù)后差有關(guān)。(4)65例HBsAg陽性B-NHL中35例應(yīng)用R-CHOP方案,其中無一例病人發(fā)生爆發(fā)性肝炎,無HBV再激活相關(guān)死亡率,30例應(yīng)用CHOP方案,R-CHOP組CR+PR率高(71.4%vs 46.7%,P=0.042),與CHOP組相比,聯(lián)合利妥昔單抗化療可提高患者總體生存時間和無進展生存時間(P0.001)。在280例HBsAg陰性患者中,觀察到有4例(HBsAg陰性/HBcAb陽性)HBsAg轉(zhuǎn)陽,4例病人均應(yīng)用R-CHOP化療方案。結(jié)論B-NHL患者HBV感染率明顯高于普通人群,HBV感染的B-NHL臨床表現(xiàn)較獨特,并且預(yù)后相對較差。利妥昔單抗可增加此類患者HBV再激活的風險,但可改善HBsAg陽性組患者預(yù)后。
[Abstract]:Objective to investigate the relationship between hepatitis B virus (HBV) infection and B cell type non Hodgkin's lymphoma (B cell Non-Hodgkin's ymphoma B NHL), and to analyze retrospectively the clinical features and prognostic factors associated with HBV infection with B-NHL. Methods the clinical data of 345 patients with primary B-NHL in three Grade 3A hospitals in Qingdao were collected and divided into HBsAg positive group (65 cases) and HBsAg negative group (280 cases). The difference of HBV infection rate between B-NHL patients and the general population was compared. The clinical characteristics and prognosis of the two groups were analyzed. Meanwhile, the HBsAg positive group was further divided into two subgroups, R-CHOP and CHOP, and survival analysis was carried out between the two subgroups. Results the positive rate of hepatitis B surface antigen-HBsAg in 345 patients with B-NHL was 18.80.Compared with the general population in China, the difference was statistically significant (18.9 vs 7.2P 0.001g. 2) compared with the negative group, the median age of B-NHL positive patients was 48 years old vs 58 years old P0.01a, which was more prone to liver involvement. Splenic or retroperitoneal lymph nodes 4.3s vs 12.3P0.013P 18.9, including P0.00935.4 vs 56.9 P0.001, 44.6%vs 66.2P 0.002 in the late stage of the disease, and poor prognosis (2-year overall survival rate 49.2%vs 71.3p0.0010.31) univariate analysis showed that adverse factors in the prognosis of HBsAg positive B-cell NHL patients included B / Ann Arbor stage IIIIV, 尾 2 microglobulin, 尾 2 microglobulin, and 尾 2 microglobulin in the patients with HBsAg positive B-cell NHL in the late stage of stage IIIIV, 尾 2 microglobulin (尾 2 microglobulin, 尾 2 microglobulin). No combination of rituximab and radiotherapy. Multivariate analysis showed that Ann Arbor stage III / IV and no Rituximab were still associated with poor prognosis in 35 of 65 patients with HBsAg positive B-NHL, none of whom developed fulminant hepatitis. Thirty patients with no HBV reactivation associated mortality were treated with CHOP regimen R-CHOP. The CR PR rate in the R-CHOP group was 71.4% vs 46.7%. Compared with the CHOP group, the combination of rituximab chemotherapy could improve the overall survival time and progression free survival time (P 0.001). Of the 280 patients with HBsAg negative, 4 patients were treated with R-CHOP regimen. Conclusion the HBV infection rate in patients with B-NHL is significantly higher than that in the general population. The clinical manifestations of HBV infection in patients with B-NHL are unique, and the prognosis is relatively poor. Rituximab increased the risk of HBV reactivation in such patients, but improved the prognosis of HBsAg positive patients.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733.1;R512.62

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