華氏巨球蛋白血癥的臨床研究
發(fā)布時間：2018-09-07 15:02
【摘要】：目的總結(jié)華氏巨球蛋白血癥(Waldenstr(?)m's macroglobulinemia,WM)的臨床特點和診治情況,分析影響預(yù)后的相關(guān)因素。方法回顧性分析2011年1月至2016年1月于鄭州大學(xué)人民醫(yī)院診治的24例WM患者的臨床資料。結(jié)果24例WM患者,男女比例2:1(男16例,女8例),中位年齡62.5(42-79)歲;最常見的臨床癥狀是疲乏(20例,83.3%);中位血紅蛋白(Hb)水平75(46~145)g/L;中位IgM水平32.9(6.4~79.3)g/L;IgMκ型18例(75%),IgMλ型6例(25%)。8例患者行骨髓活檢,其中3例網(wǎng)狀纖維染色為(++~+++)。16例行流式細胞術(shù)檢測,其中13例(81.3%)表現(xiàn)為sIgM+CD19+CD20+CD22+CD5-CD10-CD23-。全組中位無進展生存時間(PFS)7.5(1-51)個月。單因素分析結(jié)果示,年齡、Hb、血小板、IgM水平、白蛋白、β2微球蛋白、C反應(yīng)蛋白、乳酸脫氫酶、血清肌酐(SCr)及合并重度免疫不全麻痹可影響患者PFS,應(yīng)用含利妥昔單抗或硼替佐米化療方案組的PFS相對較長。多因素分析結(jié)果示,年齡(P=0.008)、IgM水平(P=0.028)及SCr(P=0.005)是WM預(yù)后不良的獨立危險因素。根據(jù)年齡、IgM水平和SCr可將WM患者分為危險程度不同的三組,三組中位PFS分別是26個月、6個月、2個月(P0.001)。結(jié)論WM好發(fā)于老年男性,以IgMκ型多見,臨床表現(xiàn)多樣且無特異性,國內(nèi)WM患者發(fā)病年齡較小,且臨床表現(xiàn)較重。WM具有惰性B細胞淋巴瘤的特點,可伴骨髓纖維化。根據(jù)年齡、IgM水平和SCr對WM患者分組有利于預(yù)后評估,利妥昔單抗或硼替佐米的應(yīng)用有望提高療效并改善預(yù)后。
[Abstract]:Objective to summarize the clinical features, diagnosis and treatment of (Waldenstr (? M macroglobulinemia,WM and to analyze the related prognostic factors. Methods the clinical data of 24 patients with WM from January 2011 to January 2016 in Renmin Hospital of Zhengzhou University were retrospectively analyzed. Results Twenty-four patients with WM were diagnosed at 2:1 (16 males and 8 females) with median age of 62.5 (42-79). The most common clinical symptoms were fatigue (20 cases, 83.3%), median hemoglobin (Hb) level (75 (460.145) g / L), median IgM level (32.9 (6.479.3) g / L IgM 魏 type (18 cases, 75%), bone marrow biopsy in 6 cases (25.8%). Among them, 3 cases were stained with (~) .16 cases were detected by flow cytometry, 13 cases (81.3%) showed sIgM CD19 CD20 CD22 CD5-CD10-CD23-.. The median progression-free survival time (PFS) was 7.5 (1-51) months. Univariate analysis showed that the age of HB, platelet titer IgM, albumin, 尾 2 microglobulin C reactive protein, lactate dehydrogenase, Serum creatinine (SCr) and severe immune insufficiency could affect the PFS of patients with PFS, treated with Rituximab or bortezomil chemotherapy regimen. Multivariate analysis showed that age (P0. 008) and SCr (P0. 005) were independent risk factors for poor prognosis of WM. The patients with WM were divided into three groups according to age and SCr. The median PFS of the three groups was 26 months, 6 months and 2 months (P0.001). Conclusion WM is more common in the elderly men, and its clinical manifestations are diverse and non-specific. The patients with WM in China have the characteristics of inert B-cell lymphoma and their clinical manifestations are characterized by inert B-cell lymphoma, which can be accompanied by bone marrow fibrosis. The classification of WM patients according to age level and SCr is beneficial to the prognosis evaluation. The application of rituximab or bortezomil is expected to improve the curative effect and improve the prognosis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733
，
本文編號：2228602
[Abstract]:Objective to summarize the clinical features, diagnosis and treatment of (Waldenstr (? M macroglobulinemia,WM and to analyze the related prognostic factors. Methods the clinical data of 24 patients with WM from January 2011 to January 2016 in Renmin Hospital of Zhengzhou University were retrospectively analyzed. Results Twenty-four patients with WM were diagnosed at 2:1 (16 males and 8 females) with median age of 62.5 (42-79). The most common clinical symptoms were fatigue (20 cases, 83.3%), median hemoglobin (Hb) level (75 (460.145) g / L), median IgM level (32.9 (6.479.3) g / L IgM 魏 type (18 cases, 75%), bone marrow biopsy in 6 cases (25.8%). Among them, 3 cases were stained with (~) .16 cases were detected by flow cytometry, 13 cases (81.3%) showed sIgM CD19 CD20 CD22 CD5-CD10-CD23-.. The median progression-free survival time (PFS) was 7.5 (1-51) months. Univariate analysis showed that the age of HB, platelet titer IgM, albumin, 尾 2 microglobulin C reactive protein, lactate dehydrogenase, Serum creatinine (SCr) and severe immune insufficiency could affect the PFS of patients with PFS, treated with Rituximab or bortezomil chemotherapy regimen. Multivariate analysis showed that age (P0. 008) and SCr (P0. 005) were independent risk factors for poor prognosis of WM. The patients with WM were divided into three groups according to age and SCr. The median PFS of the three groups was 26 months, 6 months and 2 months (P0.001). Conclusion WM is more common in the elderly men, and its clinical manifestations are diverse and non-specific. The patients with WM in China have the characteristics of inert B-cell lymphoma and their clinical manifestations are characterized by inert B-cell lymphoma, which can be accompanied by bone marrow fibrosis. The classification of WM patients according to age level and SCr is beneficial to the prognosis evaluation. The application of rituximab or bortezomil is expected to improve the curative effect and improve the prognosis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733
，
本文編號：2228602
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