结外NK/T细胞淋巴瘤患者鼻腔菌群失调与预后的关系

目的 探讨鼻腔菌群失调与结外NK/T细胞淋巴瘤（extranodal NK/T-cell lymphoma，ENKTCL）预后的相关性。方法 回顾性分析244例初治ENKTCL患者的临床资料及鼻拭子培养结果，根据是否存在鼻腔菌群失调将患者分为菌群正常组（n=114）和菌群失调组（n=130），并分析菌群失调与患者临床病理特征、治疗效果及预后的关系。结果  菌群失调组患者共培养出409株优势菌株，以金黄色葡萄球菌、草绿色链球菌、表皮葡萄球菌及铜绿假单胞菌为主。菌群失调组患者的乳酸脱氢酶升高比例高于菌群正常组（P=0.044），预后评分PINK≥1的中危或高危患者比例亦高于菌群正常组（P=0.003）。治疗结束时，菌群失调组患者的完全缓解率显著低于菌群正常组（45.5% vs 61.4%，P<0.05），5年无疾病进展生存率亦低于菌群正常组（48.4% vs 63.9%，P=0.048）。亚组分析显示，早期及PINK低危患者中，菌群失调与否与患者的无疾病进展生存期有关（P=0.022， 0.011）。结论 鼻腔菌群失调与ENKTCL患者预后密切相关，针对鼻腔菌群失调的措施可能进一步改善ENKTCL的治疗效果及预后。

Relationship between abnormal nasal microbiota and prognosis in patients with extranodal NK/T-cell lymphoma

Objective To investigate the relationship between abnormal nasal microbiota and prognosis in patients with extranodal NK/T-cell lymphoma(ENKTCL). Methods The clinical data and bacteria culture results of nasal swab of 244 newly diagnosed ENKTCL patients were retrospectively analyzed. The patients were divided into a normal microbiota group(n=114)and an abnormal microbiota group(n=130)according to the presence of abnormal microbiota,and the correlation analysis was conducted among clinical characteristics,treatment effects and prognosis. Results A total of 409 dominant strains were cultured in patients with abnormal microbiota,mainly staphylococcus aureus,streptococcus aureus,staphylococcus epidermis and pseudomonas aeruginosa. The proportion of patients with elevated lactate denhydrogenase,and medium risk or high risk with a prognostic score of PINK ≥1 in the abnormal microbiota group were significantly higher than those of the normal microbiota group(P=0.044;P=0.003). In the end of treatment,the complete response rate and 5-year progression-free survival of patients in the abnormal microbiota group were significantly lower than those in the normal microbiota group(45.5% vs 61.4%,P<0.05;48.4% vs 63.9%,P=0.048). Subgroup analysis suggested that in the early stage and low-risk PINK patients,the imbalance of flora was significantly correlated with PFS(P=0.022,0.011). Conclusions Abnormal nasal microbiota is closely related to the prognosis of patients with ENKTCL. Strategies aiming at abnormal nasal microbiotas may enhance the therapeutic effects and prognosis of ENKTCL.