不同BMI的非霍奇金淋巴瘤患者临床病理特征比较及预后关联分析-东南大学学报医学版

不同BMI的非霍奇金淋巴瘤患者临床病理特征比较及预后关联分析

单位：联勤保障部队第九八○医院, 河北石家庄 050082

分类号：R733.4

出版年·卷·期（页码）：2026·45·第一期（51-60）

摘要：

目的:探究不同体质量指数(BMI)的非霍奇金淋巴瘤(NHL)患者临床病理特征差异及预后关联。方法:以290例NHL患者为研究对象,均于2018年1月至2022年1月在本院就诊。根据世界卫生组织(WHO)BMI分类标准将研究对象分为低体质量组(BMI＜18.5 kg·m^-2)、正常组(18.5 kg·m^-2≤BMI＜24.00 kg·m^-2)、超重组(24.00 kg·m^-2≤BMI＜28.00 kg·m^-2)、肥胖组(BMI≥28.00 kg·m^-2),分别有50、90、80、70例。此外,将研究对象根据病理亚型的不同分为惰性NHL组(n=46例)和侵袭性NHL组(n=244例),惰性NHL组包括滤泡性淋巴瘤(FL),侵袭性NHL组包括弥漫大B细胞淋巴瘤(DLBCL)和套细胞淋巴瘤(MCL)。对比不同BMI分组患者临床病理特征,Kaplan-Meier法绘制生存曲线,并用Log-rank检验。采用多因素Cox比例风险模型分析影响NHL患者预后的危险因素。结果:不同BMI分组患者ECOG评分、IPI评分、EBV-DNA、乳酸脱氢酶(LDH)比较差异均有统计学意义(P<0.05)。不同BMI分组患者客观缓解率(ORR)、完全缓解率(CRR)比较差异无统计学意义(P＞0.05)。惰性NHL组和侵袭性NHL组中低体质量、正常、超重、肥胖例数占比比较差异有统计学意义(χ²=30.361,P＜0.05)。随访期间20例患者失访,失访率为6.90%(20/290),其余270例患者中有81例发生死亡,189例存活。低体质量组、正常组、超重组、肥胖组3年无进展生存(PFS)比率分别为41.67%、73.17%、67.57%、50.00%,总生存(OS)比率分别为52.08%、80.49%、78.38%、60.61%。低体质量组、肥胖组3年PFS、OS比率均低于正常组和超重组(P<0.05)。在侵袭性NHL组患者中,BMI与3年PFS、OS比率显著相关(P<0.05),而在惰性NHL组患者中未观察到类似关联(P>0.05)。单因素分析结果显示,ECOG评分、Ann Arbor分期、IPI评分、B症状、β₂-微球蛋白、EBV-DNA、LDH、BMI、病理亚型对NHL患者PFS的预后有影响(P<0.05);年龄、ECOG评分、Ann Arbor分期、IPI评分、B症状、β₂-MG、EBV-DNA、LDH、BMI、病理亚型对NHL患者OS的预后有影响(P<0.05)。多因素Cox回归分析结果显示,IPI评分≥2分、EBV-DNA阳性、低体质量及肥胖、侵袭性是影响NHL患者PFS及OS预后的独立危险因素(P<0.05)。结论:低体质量和肥胖是NHL患者预后不良的独立危险因素,且与临床病理特征(ECOG评分、IPI评分、EBV-DNA、LDH)密切关联。

Objective: To explore the difference of clinicopathological characteristics and prognostic association among patients with non-Hodgkin's lymphoma(NHL) of different body mass index(BMI). Methods: A total of 290 patients with NHL were enrolled in this study, all of whom received care at our hospital between January 2018 and January 2022. According to the World Health Organization(WHO) body mass index(BMI) classification criteria, the patients were divided into four groups: underweight(BMI<18.5 kg·m^-2), normal weight(18.5 kg·m^-2≤BMI<24.0 kg·m^-2), overweight(24.0 kg·m^-2≤ BMI<28.0 kg·m^-2), and obese(BMI≥28.0 kg·m^-2), with 50, 90, 80, and 70 patients in each group, respectively. In addition, the research subjects were divided into the indolent NHL group(n=46) and the aggressive NHL group(n=244) based on different pathological subtypes. The indolent NHL group included follicular lymphoma(FL), while the aggressive NHL group included diffuse large B-cell lymphoma(DLBCL) and mantle cell lymphoma(MCL). The clinicopathological characteristics of patients in different BMI groups were compared. The survival curves were plotted by the Kaplan-Meier method and the Log-rank test was used. The risk factors influencing the prognosis of NHL patients were analyzed using a multivariate Cox proportional hazards model. Results: There were significant differences in ECOG score, IPI score, EBV-DNA, and LDH among patients in different BMI groups(P<0.05). There was no difference in ORR and CRR among patients with different BMI groups(P>0.05); however there was a significant difference in the proportion of low weight, normal, overweight and obese cases between the indolent NHL group and the aggressive NHL group(χ²=30.361, P<0.05). During the follow-up period, 20 patients were lost to follow-up, with the loss rate being 6.90%(20/290). Among the remaining 270 patients, 81 died and 189 survived. The 3-year progression-free survival(PFS) rates of the low weight group, normal group, overweight group and obese group were 41.67%, 73.17%, 67.57% and 50.00% respectively, and the overall survival(OS) rates were 52.08%, 80.49%, 78.38% and 60.61% respectively. In the aggressive NHL group, BMI was significantly correlated with 3-year PFS and OS rate(P<0.05), while no similar association was observed in the indolent NHL group(P>0.05). The results of univariate analysis showed that ECOG score, Ann Arbor stage, IPI score, B symptoms,β₂-MG, EBV-DNA, LDH, BMI, and pathological subtype had an impact on the prognosis of PFS in NHL patients(P<0.05). Age, ECOG score, Ann Arbor stage, IPI bisection, B symptom, β₂-MG, EBV-DNA, LDH and BMI exerted an impact on the prognosis of PFS in NHL patients(P<0.05). The results of multivariate Cox regression analysis showed that IPI bisection ≥2 points, positive EBV-DNA, low body weight and obesity, and inasiveness were independent risk factors affecting the prognosis of PFS and OS in NHL patients(P<0.05). Conclusion: Low body weight and obesity are independent risk factors for poor prognosis in patients with NHL, and are closely related to clinicopathological characteristics(ECOG score, IPI score, EBV-DNA, LDH).

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