本文關(guān)鍵詞： 彌漫大B細(xì)胞淋巴瘤 國(guó)際預(yù)后指數(shù) 免疫亞型 分子標(biāo)志物 預(yù)后　出處：《青海大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:彌漫大B細(xì)胞淋巴瘤(diffuse large B-cell lymphom,DLBCL)是非霍奇金淋巴瘤中最為常見的一類具有明顯異質(zhì)性的惡性腫瘤。本文探討59例初診DLBCL患者的一般臨床資料及免疫組織化學(xué)資料特點(diǎn),并分析其預(yù)后意義,進(jìn)一步從分子水平上認(rèn)識(shí)DLBCL。方法:收集2010年08月至2015年12月在青海大學(xué)附屬醫(yī)院經(jīng)病理及免疫組織化學(xué)檢查確診的59例DLBCL患者的病例資料,即一般臨床資料(性別、年齡、臨床分期、ECOG評(píng)分、原發(fā)部位、IPI、外周血ALC、血清LDH)、免疫組織化學(xué)資料(免疫亞型、Bcl-2、Ki-67、CD5)及治療方法、總生存期,探討DLBCL患者發(fā)病的一般情況、分子標(biāo)志物等指標(biāo)特點(diǎn)及各指標(biāo)在預(yù)后中的意義。應(yīng)用SPSS21.0進(jìn)行統(tǒng)計(jì)學(xué)分析,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.一般情況:59例初診DLBCL患者中,男女比例為1.36:1,平均發(fā)病年齡為56.80±13.70(16~87)歲,外周血ALC和血清LDH水平在I+II期、III+IV期組兩組中比較差異有統(tǒng)計(jì)學(xué)意義(P=0.030、0.045)。2.原發(fā)部位:59例初診的DLBCL患者,其中33(55.93%)例為原發(fā)淋巴結(jié)內(nèi)的患者;26(44.07%)例為原發(fā)淋巴結(jié)外的患者,結(jié)外部位中以原發(fā)胃部最多為8(32.00%)例,僅1例患者原發(fā)于中樞神經(jīng)系統(tǒng),其發(fā)病特點(diǎn)為臨床分期較晚、ECOG評(píng)分3分、結(jié)外累及病變數(shù)≥2個(gè)、non-GCB型、Ki-67為80%。生存分析顯示,原發(fā)胃DLBCL患者的3年OS率與其他結(jié)外患者比較,差異無統(tǒng)計(jì)學(xué)意義(71.4%vs 72.5%,P=0.465)。3.免疫組織化學(xué)檢查:免疫亞型在全組53例DLBCL患者中的分布情況為non-GCB型較多見,與在結(jié)內(nèi)、結(jié)外、胃部及非胃部中的分布情況一致。Ki-67平均表達(dá)水平為63.13%±16.90%(20%~90%),高表達(dá)(Ki-67≥50%)患者占80.36%;Bcl-2陽性表達(dá)的患者高達(dá)80.65%;部分患者(33.33%)CD5陽性表達(dá)。GCB型患者的3年OS率高于non-GCB型患者(87.5%vs 47.7%,P=0.043);Bcl-2、CD5陽性表達(dá)患者的3年OS率與陰性表達(dá)患者比較,差異無統(tǒng)計(jì)學(xué)意義(65.3%vs 50.0%,P=0.474;66.7%vs 100.0%,P=0.248),3年OS率在Ki-67高、低表達(dá)患者中亦無明顯差異(62.5%vs 67.1%,P=0.635)。4.生存分析:年齡、臨床分期、ECOG評(píng)分、IPI、免疫亞型、有無應(yīng)用R治療與DLBCL的預(yù)后密切相關(guān)(P值分別為0.020、0.017、0.032、0.009、0.043、0.013)。Bcl-2、Ki-67、CD5對(duì)DLBCL患者的3年OS率無明顯影響(P0.05)。IPI、免疫亞型及有無應(yīng)用R治療為DLBCL的獨(dú)立預(yù)后因素(P值分別為0.017、0.009、0.030)。結(jié)論:1.外周血ALC、血清LDH在不同臨床分期患者中的變化可作為監(jiān)測(cè)DLBCL病情動(dòng)態(tài)變化的重要指標(biāo)。2.DLBCL中,原發(fā)淋巴結(jié)內(nèi)患者較結(jié)外多見,結(jié)外以原發(fā)胃腸道最多。3.DLBCL發(fā)病時(shí),non-GCB型患者較常見,Bcl-2陽性、Ki-67高表達(dá)患者多見,部分患者CD5陽性表達(dá)。4.免疫亞型、年齡、臨床分期、IPI、ECOG評(píng)分、有無應(yīng)用R治療是DLBCL的預(yù)后因素,影響患者的3年OS率;Bcl-2、Ki-67、CD5蛋白表達(dá)對(duì)患者的3年OS率無明顯影響。免疫亞型、IPI、有無應(yīng)用R治療是影響DLBCL患者3年OS率的獨(dú)立預(yù)后因素。
[Abstract]:Objective: diffuse large B-cell lymphoma (DLBCLs) is the most common type of malignant tumor with obvious heterogeneity in non-Hodgkin 's lymphoma. The clinical and immunohistochemical characteristics of 59 newly diagnosed DLBCL patients were studied. The prognostic significance of DLBCL.Methods: from August 2010 to December 2015, 59 cases of DLBCL confirmed by pathological and immunohistochemical examination in affiliated Hospital of Qinghai University were collected. That is, general clinical data (sex, age, clinical stage and ECOG score, primary site of IPI, peripheral blood ALC, serum LDHH, immunohistochemical data (immune subtype Bcl-2Ki-67-CD5), treatment method, total survival period, to explore the general situation of DLBCL patients. The significance of molecular markers and other indexes in prognosis was statistically significant using SPSS21.0. Results: 1. In the general situation of 59 newly diagnosed DLBCL patients, the ratio of male to female was 1.36: 1, and the average age of onset was 56.80 鹵13.701687.The results showed that the average age of onset was 56.80 鹵13.701687.Results in the general situation, the ratio of male to female was 1.36: 1 in 59 newly diagnosed DLBCL patients. The levels of ALC in peripheral blood and LDH in serum were significantly different between the two groups in III stage III IV group. There was a significant difference between the two groups. Among the 59 newly diagnosed DLBCL patients, 3355.93 were primary lymph node patients and 2644.07 were primary lymph nodes. In the external nodal position, the primary stomach was 832. 00) and only 1 patient was primary in the central nervous system. The disease was characterized by late clinical stage and ECOG score 3, and the number of extranodular involvement 鈮，

本文編號(hào)：1551405