套细胞淋巴瘤患者外周血NK细胞数目变化及其临床意义

摘要

目的:探讨外周血NK细胞数目变化在套细胞淋巴瘤(mantle cell lymphoma,MCL)患者中的临床意义.方法:以本院2003年11月至2011年11月收治的84例套细胞淋巴瘤患者为研究对象.采集所有患者空腹静脉血于24 h内染色并上流式细胞仪检测.记录患者年龄、性别、病理分型、B症状、临床分期、NK细胞绝对数(ANKC)、血红蛋白、乳酸脱氢酶、β2微球蛋白、骨髓浸润情况和套细胞淋巴瘤国际预后指数(MIPI).对所有患者均进行随访.结果:患者不同年龄、性别、是否合并B症状、Ann Arbor分期、Hb和LDH水平、是否有骨髓浸润、β2微球蛋白和MIPI间的ANKC值差异均无统计学意义(P＞0.05).ROC曲线分析ANKC预测预后的最佳阈值为0.10×109/1,AUC为0.798(95％ CI:0.689-0.902) (P＜ 0.01),敏感性和特异性分别为74.6％和73.8％.ANKC≥0.10×109/L患者3年无进展生存期率(62.8％)高于ANKC＜ 0.10×109/L患者(32.1％)(P＜0.01).ANKC≥0.10×109/L患者3年总生存期率(81.5％)高于ANKC ＜0.10×109/1患者(43.8％)(P＜0.01).多因素分析显示,影响MCL患者PFS和OS的独立预测因素为外周血ANKC值和MIPI(P＜0.05).结论:外周血NK细胞数目的变化对判断MCL患者预后具有重要的临床价值,可作为临床判断MCL患者病情的重要监测指标.%Objective:To investigate the clinical significance of peripheral blood NK cell number change in patients with mantle cell lymphoma.Methods:Eight-four patients with mantle cell lymphoma treated in our hospital from November 2003 to November 2011 were studied,the venous blood was collected from all patients and detected with flow cytometry.The age,sex,pathologic type,B-symptoms,clinical stage,absolute NK count (ANKC),hemoglobin (Hb),lactate dehydrogenase (LDH) and β2-microglobulin (β2-MG) levels,bone marrow involuement (BMI) and the international prognostic index of mantle cell lymphoma(MIPI) were recorded.All patients were followed up.Results:There were no significant differences in ANKC among different age,sex,B symptom,Ann Arbor stages,Hb,LDH and β2-MG levels,BMI and MIPI of patients with MCL(P ＞0.05).The sensitivity and specificity of ANKC were 76.6％ and 73.8％,respectively.The optimal throshold of ANKC was 0.10 × 109/L and AUC was 0.798(95％ CI:0.689-0.902)(P ＜0.01).The 3 year-PFS rate in patients with ANKC≥0.10 × 109/L was higher than that in patients with ANKC ＜ 0.10 × 109/L(68.2％ vs 32.10％) (P ＜ 0.01).The 3 year-OS rate in patients with ANKC ≥ 0.10 × 109/L was significantly higher than that in patients with ANKC ＜0.10 × 109/L (85.1％ vs 43.8％) (P ＜0.01).Multivariate analysis showed that the independent predictors of PFS and OS in patients with MCL were ANKC and MIPI(P ＜ 0.05).Conclusion:The ANKC in peripheral blood has an important value for judging the prognosis of patients with MCL and can be used as an important index to judge the disease status of patients with MCL.