乙肝病毒感染与弥漫大B细胞淋巴瘤关联研究

目的 探讨弥漫大B细胞淋巴瘤(DLBCL)发病与乙肝病毒(HBV)感染的相关性,以及合并HBV感染DLBCL患者的临床和病理学特征.方法 采用多中心、以医院为基础的1∶4病例对照研究,收集初治DLBCL患者410例,选择同期性别、年龄相匹配的1640例健康体检者为对照组.采用ELISA法检测研究对象的乙肝五项,比较组间阳性率的差异,并分析HBV感染组与未感染组DLBCL患者的临床及病理学异同.结果 DLBCL患者HBsAg阳性率明显高于对照组(12.68％ vs4.57％,P＜0.01),OR值为3.03(2.09-4.40);抗-HBc阳性率也明显高于对照组(51.22％ vs38.48％,P＜0.01),OR值为1.68(1.35-2.09).DLBCL患者中,HBV慢性和既往感染者＜45岁年龄所占比例明显多于未感染组(P＜0.01),HBV慢性感染者的肝功受损比例较高(P＜0.01),而且HBV慢性和既往感染者在肿瘤细胞起源上与未感染者存在明显差异(P＜0.01),常见累及部位为淋巴结和脾脏.结论 HBV可能是DLBCL发病的危险因素之一;HBV感染的DLBCL患者肿瘤细胞起源以生发中心型多见;化疗时需要密切监测其HBV血清学和肝功变化.

Correlation study of hepatitis B virus infection and diffuse large B-cell lymphoma

Objective To explore the correlation between the diffuse large B cell lymphoma (DLBCL) and hepatitis B virus (HBV) infection,and to describe clinical and pathological characteristics of DLBCL patients with HBV infection.Methods A multicenter,hospital-based,case control study was used.Four-hundred and ten cases of DLBCL were chosen as case group,and 1640 individuals for health examination were matched as control group.The serum markers of HBV infections were tested by ELISA.HBV infection status,clinical and pathology features were compared between different groups.Results HBsAg positive rate in DLBCL group was significantly higher than control group (12.68％ vs 4.57％,P ＜ 0.01),and its OR value was 3.03(2.09-4.40);anti-HBc positive rate was also significantly higher than the control group (51.22％ vs38.48％,P＜0.01),its OR value was 1.68 (1.35-2.09).Among DLBCL patients,the proportions of patients ＜ 45 years old age with chronic and history of HBV infections and percentage of hepatic damage were significantly higher than that in the control group (P ＜0.01).There were also significant difference in the origins of the tumor cells in both groups (P ＜ 0.01).Conclusions HBV infection may be one of the risk factors of DLBCL.The origin of DLBCL with HBV infection patients was mainly germinal center B-cell-like cells.Monitoring of serological markers and liver function are needed during chemotherapy.