青海地区淋巴瘤253例临床特点与预后因素分析

目的 分析淋巴瘤的临床特点及预后相关因素.方法 对青海地区253例淋巴瘤患者临床资料进行回顾性研究并随访.采用Kaplan-Meier法分析患者不同临床特点及实验室检查的生存期差异.采用Cox比例风险回归模型分析影响预后的因素.结果 253例淋巴瘤患者中,男、女比例为1.56∶1,中位年龄为48岁,发病年龄高峰为40岁和60岁左右.结内起病（56.13％）较多,结外起病常见部位为鼻咽部和胃肠道.病理类型为霍奇金淋巴瘤40例（15.81％）,非霍奇金淋巴瘤213例（84.19％）.前者以结节硬化型（72.50％）最多见;后者中B细胞淋巴瘤148例（69.48％）,最常见的病理类型为弥漫大B细胞淋巴瘤（39.91％）、滤泡细胞淋巴瘤（12.21％）及周围T细胞非特殊型淋巴瘤（9.39％）.单因素预后分析显示,临床分期、有无B症状、血红蛋白（Hb）、乳酸脱氢酶（LDH）、国际预后指数（IPI）及治疗方案与非霍奇金淋巴瘤预后密切相关（均P＜0.05）.Cox回归模型多因素分析显示,临床分期、IPI及治疗方案与非霍奇金淋巴瘤的预后关系密切,差异有统计学意义（均P＜0.05）.结论 青海地区淋巴瘤发病年龄有两个高峰,结内发病高于结外,B细胞淋巴瘤多见,IPI分组适用于该地区非霍奇金淋巴瘤的预后评估,并可作为其独立的预后因素.

Analysis of clinical characteristics and prognostic factors of 253 lymphoma cases in Qinghai

Objective　To analyze the clinical features and prognostic factors of lymphoma. Methods　The clinical data, pathologic data and survival state of 253 patients with lymphoma in Qinghai were retrospectively studied. The survival differences of patients with different clinical characteristics and laboratory tests were analyzed using Kaplan-Meier method. The prognostic factors of lymphoma were analyzed by Cox proportional hazards regression model. Results　Among all of 253 cases of lymphoma, males were in the majority (male∶female = 1.56∶1). The median age of patients was 48 years old. There were two peaks of about 40 years old and 60 years old in age of onset. The nodal lymphoma (56.13 %) was more commonly than the extranodal lymphoma (43.87 %). The more common extranodal lymphomas were found in the nasopharynx and gastrointestinal tract. Among all cases, 40 cases (15.81 %) were confirmed to be Hodgkin lymphoma (HL), of which, the commonest subtype was nodular sclerosis (72.5 %). While 213 of 253 cases (84.19 %) belonged to non-Hodgkin lymphoma (NHL), of which, B-cell lymphoma was 148 cases (69.48 %). Overall, three subtypes including diffuse large B-cell lymphoma (39.91 %), follicular lymphoma (12.21 %) and peripheral T-cell lymphoma (9.39 %) were the commonest subtypes among all cases. Univariate analysis showed that the clinical stage, B symptoms, Hb concentration, serum LDH level, international prognostic score (IPI) and treatment programs were related to the prognosis of NHL (P < 0.05). However, the Cox regression multivariate analysis showed that only the clinical stage, IPI and treatment programs, not B symptoms, Hb concentration and serum LDH level, were closely related to the prognosis of NHL (P < 0.05). Conclusions　In Qinghai area, there are two peaks of about 40 and 60 years old in the age of onset of lymphoma. The nodal lymphoma is more than extranodal lymphoma. B-cell lymphoma is more common. IPI could be as an independent prognostic factor and might be used to estimate the prognosis of NHL.