白蛋白与纤维蛋白原的比值预测弥漫大B细胞淋巴瘤患者预后的价值

目的:探讨血清白蛋白（albumin，ALB）与血浆纤维蛋白原（fibrinogen，FIB）的比值（ALB to FIB ratio，AFR）对弥漫大B细胞淋巴瘤（diffuse large B-cell lymphoma，DLBCL)患者预后的影响。方法:选择我院2015-04-17至2022-03-18确诊的DLBCL病例59例，收集所有患者首次化疗前1周内的血清ALB值、血浆FIB值，计算出AFR。应用生存分析研究AFR对DLBCL患者无进展生存率(progression free survival，PFS)的影响。应用受试者工作特征曲线(receiver operating characteristic curve,ROC)下的面积（area under the ROC curve,AUC）来评估各模型对DLBCL患者预后预测能力的大小。结果:AFR范围3.87～20.13，中位数11.16。AFR与IPI、Ann Arbor分期、结外侵犯数以及B症状密切相关。Kaplan-Meier生存分析提示，AFR增高时，DLBCL患者的PFS显著提高（P＜0.001），2年累积PFS与低AFR组患者相比提高了73.0%。Cox单因素分析提示，低AFR的DLBCL患者发生肿瘤进展或死亡的风险显著增加（P=0.002）；多因素分析提示，AFR是影响DLBCL患者PFS的独立因素（P=0.004）。国际预后指数（international prognostic index，IPI）和IPI联合AFR两种模型判断DLBCL患者PFS的AUC值分别为0.778（95%CI 0.659～0.897,P＜0.001）和0.829（95%CI 0.723～0.935,P＜0.001）。结论:AFR是判断DLBCL患者PFS的独立预测因子，IPI联合AFR能够更好地判断DLBCL患者的预后。

Prognostic value of albumin to fibrinogen ratio in diffuse large B-cell lymphoma

Objective:To explore the effect of serum albumin(ALB) to plasma fibrinogen（FIB）ratio（AFR）on the prognosis of patients with diffuse large B-cell lymphoma（DLBCL）.Methods:Fifty nine cases of DLBCL diagnosed in our hospital from April 17th,2015 to March 18th,2022 were selected.The serum ALB and plasma FIB of all patients within 1 week before the first chemotherapy were collected to calculate the AFR.The impact of AFR on the progression free survival (PFS) of patients with DLBCL was evaluated by survival analysis.The area under the receiver operating characteristic (ROC) curve (AUC) was used to assess the capability of each model to predict the prognosis of DLBCL patients.Results:The range of AFR was from 3.87 to 20.13,with a median of 11.16.AFR was closely related to IPI,Ann Arbor staging,extranodal invasion and B symptoms.Kaplan-Meier survival analysis showed that the PFS of DLBCL patients increased significantly when AFR increased（P＜0.001）.Compared with low AFR group,the 2-year PFS of high AFR group increased by 73.0%.Cox univariate analysis showed that low AFR was a risk factor for PFS of DLBCL patients（P=0.002）.Multivariate analysis indicated that AFR was an independent factor affecting PFS of DLBCL patients（P=0.004）.The AUC values of international prognostic index (IPI) and IPI combined with AFR in predicting PFS of DLBCL patients were 0.778（95%CI 0.659～0.897,P＜0.001）and 0.829（95%CI 0.723～0.935,P＜0.001）respectively.Conclusion:AFR is an independent predictor of PFS in patients with DLBCL.IPI combined with AFR can better evaluate the prognosis of patients.