霍奇金淋巴瘤患者中EB病毒感染狀態(tài)及預(yù)后分析
發(fā)布時(shí)間：2019-02-15 21:10
【摘要】：目的：霍奇金淋巴瘤與EB病毒(Epstein-Barr virus EBV)感染密切相關(guān),不同地區(qū)、人種間EBV感染率不同；本文為評(píng)估我院近7年收治霍奇金淋巴瘤患者中EBV感染狀態(tài)檢測(cè)情況,并將EBV感染對(duì)患者治療及預(yù)后的影響進(jìn)行了回顧性分析。方法：按照WHO淋巴瘤分類標(biāo)準(zhǔn),對(duì)我院2008.2至2014.10收治的全部霍奇金淋巴瘤進(jìn)行篩選,篩選出通過(guò)原位雜交方法檢測(cè)蠟塊中EBV編碼的RNA(Epstein-Barr Virus Encoded RNA,EBER)或通過(guò)免疫組化方法檢測(cè)蠟塊中潛伏膜蛋白-1(Latent membrane protein-1, LMP-1)表達(dá)確定EBV感染狀態(tài)的207例初治霍奇金淋巴瘤患者,收集基本信息、治療方法、療效及生存信息,對(duì)信息進(jìn)行回顧性分析與總結(jié),統(tǒng)計(jì)EBV陽(yáng)性率,分析EBV感染狀態(tài)與疾病狀態(tài)的相關(guān)性及對(duì)患者預(yù)后的影響；分析兒童、老年霍奇金淋巴瘤臨床特征及EBV感染特征。結(jié)果：2008年2月至2014年10月共收治霍奇金淋巴瘤329例,篩選符合條件207例。207例中191例檢測(cè)了EBER,64例(33.5%)陽(yáng)性；16例檢測(cè)了LMP-1,2例(12.5%)陽(yáng)性,總陽(yáng)性率31.9%。EBV陽(yáng)性患者中,男性多見(jiàn)(69.7%),混合細(xì)胞型為主(52.9%),多合并β2微球蛋白升高。EBV陽(yáng)性發(fā)病年齡有兩個(gè)高峰,分別是在兒童(年齡0-15歲)和老年(年齡60歲),EBV陽(yáng)性率分別為47.4%和71.4%；在16-60歲成人患者,EBV陽(yáng)性率隨年齡的增加而升高。不同地域間比較,西部地區(qū)患者中EBV陽(yáng)性率高于東部、東北部及中部地區(qū)患者(45.5%比30.6%、26.8%、28.0%,P0.05)。單因素分析結(jié)果提示,EBV陽(yáng)性患者的總生存時(shí)間(OS)短于EBV陰性組,無(wú)進(jìn)展生存時(shí)間(PFS)無(wú)統(tǒng)計(jì)學(xué)差異；年齡60歲老年患者OS和PFS均短于0-15歲和16-60歲組；血清白蛋白40g/L患者OS和PFS均短于對(duì)照組；早期患者中,接受放療治療可延長(zhǎng)PFS,但對(duì)OS無(wú)影響。多因素預(yù)后分析模型提示EBV陽(yáng)性是總生存時(shí)間的不良預(yù)后因素。兒童患者(0-15歲組)HL19例,中位年齡12歲,EBV陽(yáng)性率為47.4%,0-9歲組和10-15歲組EBV陽(yáng)性分別為66.7%和38.5%；治療模式多為化放療聯(lián)合治療,中位隨訪35個(gè)月,全組患者長(zhǎng)期生存,且未出現(xiàn)心臟毒性等遠(yuǎn)期毒性。年齡≥60歲老年HL 16例,中位年齡65歲,EBV陽(yáng)性率為75.0%,病理類型以混合細(xì)胞型為主(68.8%),接受過(guò)放療治療患者OS較未接受過(guò)放療治療組長(zhǎng)(P=0.078)。結(jié)論：EBV感染與霍奇金淋巴瘤存在一定相關(guān)性,本中心207例初治霍奇金淋巴瘤患者中EBV陽(yáng)性檢測(cè)率31.9%,病理類型以混合細(xì)胞型為主,且兒童及老年患者中多見(jiàn)；在不同地域間,西部患者EBV陽(yáng)性率高于其他地區(qū)。和EBV陰性患者相比,EBV陽(yáng)性患者總生存時(shí)間短。
[Abstract]:Objective: Hodgkin's lymphoma is closely related to EB virus (Epstein-Barr virus EBV) infection), and EBV infection rate is different in different regions and ethnic groups. In order to evaluate the status of EBV infection in patients with Hodgkin's lymphoma treated in our hospital in recent 7 years, the influence of EBV infection on the treatment and prognosis of patients was analyzed retrospectively. Methods: according to the classification criteria of WHO lymphoma, all Hodgkin's lymphomas treated in our hospital from 2008.2 to 2014.10 were screened, and the RNA (Epstein-Barr Virus Encoded RNA,) encoding EBV in wax was screened by in situ hybridization. EBER) or the expression of latent membrane protein-1 (1 (Latent membrane protein-1, LMP-1) in paraffin mass was detected by immunohistochemistry in 207patients with newly diagnosed Hodgkin's lymphoma. The basic information, treatment method, curative effect and survival information were collected. The information was retrospectively analyzed and summarized, the positive rate of EBV was counted, the correlation between EBV infection and disease status and the influence on the prognosis of patients were analyzed. The clinical and EBV infection characteristics of Hodgkin's lymphoma in children and elderly were analyzed. Results: from February 2008 to October 2014, 329 cases of Hodgkin's lymphoma were treated. 191 of 207 cases (33.5%) were positive for EBER,64. The positive rate of LMP-1,2 was 12.5% (16 / 16). The total positive rate of 31.9%.EBV was 69.7% (male), 52.9% (52.9%) in mixed cell type, 69.7% (69.7%) in male and 52.9% (52.9%) in mixed cell type. There were two peaks in the onset age of EBV positive in children (ages 0-15 years) and old people (age 60 years old), the positive rates of), EBV were 47.4% and 71.4%, respectively. In adults aged 16-60, the positive rate of EBV increased with age. The positive rate of EBV in the western region was higher than that in the eastern part and the northeast and central region (45.5% vs 30.626.8%, P 0.05). Univariate analysis showed that the total survival time (OS) of EBV positive patients was shorter than that of EBV negative group, and no significant difference was found in (PFS), OS and PFS were shorter in 60 years old patients than those in 0-15 years and 16-60 years groups. Both OS and PFS were shorter in patients with serum albumin 40g/L than those in control group. In early patients, radiotherapy could prolong PFS, but had no effect on OS. Multivariate prognostic analysis showed that EBV positive was a poor prognostic factor for total survival time. The median age of HL19 was 12 years old. The positive rate of EBV was 47.4% in 0-9 years group and 66.7% in 10-15 years old group. The positive rate of EBV was 38.5% in 10-15 years old group and 66.7% in 0-15 years old group. Most of the patients were treated by combined chemotherapy and radiotherapy. The median follow-up was 35 months. The patients survived for a long time, and there was no long-term toxicity such as cardiac toxicity. The median age was 65 years old. The positive rate of EBV was 75.0%. The pathological type was mainly mixed cell type (68.8%). The OS of the patients who had been treated with radiotherapy was higher than that of the patients without radiotherapy (P0. 078). Conclusion: there is a certain correlation between EBV infection and Hodgkin's lymphoma. The positive detection rate of EBV in 207 cases of newly treated Hodgkin's lymphoma is 31.9.The pathological type is mainly mixed cell type, and it is more common in children and elderly patients. The positive rate of EBV in western patients was higher than that in other regions. The total survival time of EBV positive patients was shorter than that of EBV negative patients.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R733.1
，
本文編號(hào)：2423699
[Abstract]:Objective: Hodgkin's lymphoma is closely related to EB virus (Epstein-Barr virus EBV) infection), and EBV infection rate is different in different regions and ethnic groups. In order to evaluate the status of EBV infection in patients with Hodgkin's lymphoma treated in our hospital in recent 7 years, the influence of EBV infection on the treatment and prognosis of patients was analyzed retrospectively. Methods: according to the classification criteria of WHO lymphoma, all Hodgkin's lymphomas treated in our hospital from 2008.2 to 2014.10 were screened, and the RNA (Epstein-Barr Virus Encoded RNA,) encoding EBV in wax was screened by in situ hybridization. EBER) or the expression of latent membrane protein-1 (1 (Latent membrane protein-1, LMP-1) in paraffin mass was detected by immunohistochemistry in 207patients with newly diagnosed Hodgkin's lymphoma. The basic information, treatment method, curative effect and survival information were collected. The information was retrospectively analyzed and summarized, the positive rate of EBV was counted, the correlation between EBV infection and disease status and the influence on the prognosis of patients were analyzed. The clinical and EBV infection characteristics of Hodgkin's lymphoma in children and elderly were analyzed. Results: from February 2008 to October 2014, 329 cases of Hodgkin's lymphoma were treated. 191 of 207 cases (33.5%) were positive for EBER,64. The positive rate of LMP-1,2 was 12.5% (16 / 16). The total positive rate of 31.9%.EBV was 69.7% (male), 52.9% (52.9%) in mixed cell type, 69.7% (69.7%) in male and 52.9% (52.9%) in mixed cell type. There were two peaks in the onset age of EBV positive in children (ages 0-15 years) and old people (age 60 years old), the positive rates of), EBV were 47.4% and 71.4%, respectively. In adults aged 16-60, the positive rate of EBV increased with age. The positive rate of EBV in the western region was higher than that in the eastern part and the northeast and central region (45.5% vs 30.626.8%, P 0.05). Univariate analysis showed that the total survival time (OS) of EBV positive patients was shorter than that of EBV negative group, and no significant difference was found in (PFS), OS and PFS were shorter in 60 years old patients than those in 0-15 years and 16-60 years groups. Both OS and PFS were shorter in patients with serum albumin 40g/L than those in control group. In early patients, radiotherapy could prolong PFS, but had no effect on OS. Multivariate prognostic analysis showed that EBV positive was a poor prognostic factor for total survival time. The median age of HL19 was 12 years old. The positive rate of EBV was 47.4% in 0-9 years group and 66.7% in 10-15 years old group. The positive rate of EBV was 38.5% in 10-15 years old group and 66.7% in 0-15 years old group. Most of the patients were treated by combined chemotherapy and radiotherapy. The median follow-up was 35 months. The patients survived for a long time, and there was no long-term toxicity such as cardiac toxicity. The median age was 65 years old. The positive rate of EBV was 75.0%. The pathological type was mainly mixed cell type (68.8%). The OS of the patients who had been treated with radiotherapy was higher than that of the patients without radiotherapy (P0. 078). Conclusion: there is a certain correlation between EBV infection and Hodgkin's lymphoma. The positive detection rate of EBV in 207 cases of newly treated Hodgkin's lymphoma is 31.9.The pathological type is mainly mixed cell type, and it is more common in children and elderly patients. The positive rate of EBV in western patients was higher than that in other regions. The total survival time of EBV positive patients was shorter than that of EBV negative patients.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R733.1
，
本文編號(hào)：2423699
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