| 赵 可,江 伟,俞 翔,等.第3腰椎骨骼肌指数在弥漫大B细胞淋巴瘤患者中的临床意义[J].肿瘤学杂志,2025,31(4):326-335. |
| 第3腰椎骨骼肌指数在弥漫大B细胞淋巴瘤患者中的临床意义 |
| Clinical Significance of Skeletal Muscle Index at the Third Lumbar Vertebra Level in Patients with Diffuse Large B-Cell Lymphoma |
| 投稿时间：2024-07-19 |
| DOI：10.11735/j.issn.1671-170X.2025.04.B008 |
|
 |
| 中文关键词: 肌肉减少症 第3腰椎骨骼肌指数 弥漫大B细胞淋巴瘤 临床特征 预后 |
| 英文关键词:sarcopenia skeletal muscle index at the third lumbar vertebra level diffuse large B-cell lymphoma clinical features prognosis |
| 基金项目:国家自然科学基金（82070206）；天津市医学重点学科（专科）建设项目（TJYXZDXK-053B） |
|
| 摘要点击次数: 0 |
| 全文下载次数: 0 |
| 中文摘要: |
| 摘 要：［目的］探讨第3腰椎骨骼肌指数（skeletal muscle index at the third lumbar vertebra level，L3-SMI）与弥漫大B细胞淋巴瘤（diffuse large B-cell lymphoma，DLBCL）患者临床病理特征和预后的关系。［方法］ 回顾性分析在天津市人民医院初诊并接受利妥昔单抗联合化疗方案治疗的153例DLBCL患者资料，使用CT测量腰3椎体水平截面的肌肉面积并计算L3-SMI，根据定义的性别特异性阈值，分为肌肉减少症组和非肌肉减少症组，分析两组临床特征、治疗效果及生存预后差异。［结果］ 153例DLBCL患者中，31 例（20.3%）诊断为肌肉减少症。与非肌肉减少症组相比，肌肉减少症组与更多的不良临床特征相关，包括B症状、结外受累≥2个部位、晚期（Ⅲ~Ⅳ期）、较高的国际预后指数和美国东部肿瘤协作组评分、低体质指数（P均<0.05）；且肌肉减少症组疾病进展率（17.2% vs 32.3%）更高，治疗完全缓解率（57.4% vs 35.5%）和5年总生存（overall survival，OS）率（ 65.2% vs 43.7%）更低（P均<0.05）。多因素分析结果显示，L3-SMI降低、乳酸脱氢酶（lactate dehydrogenase，LDH）升高和白蛋白（albumin，ALB）<40 g/L是影响男性患者OS的独立危险因素。男性患者中，肌肉减少症组和非肌肉减少症组5年OS率分别为32.3%和62.3%（P=0.006）；合并LDH升高或ALB <40 g/L的肌肉减少症组和非肌肉减少症组患者5年OS分别为0 vs 51.5%（P=0.006）和11.4% vs 48.0%（P=0.027）。［结论］ 基于L3-SMI定义的肌肉减少症是判断DLBCL患者（尤其是男性）预后的重要指标。出现肌肉减少症的男性DLBCL患者，尤其是合并LDH升高或ALB<40 g/L的患者需要更个体化的治疗。 |
| 英文摘要: |
| Abstract：［Objective］ To investigated the relationship of skeletal muscle index at the third lumbar vertebra level(L3-SMI) with clinicopathological features and prognosis in patients with diffuse large B-cell lymphoma (DLBCL). ［Methods］ Clinical data of 153 newly diagnosed DLBCL patients treated with Rituximab combined with chemotherapy in Tianjin Municipal People’s Hospital were retrospectively analyzed. The muscle area at the third lumbar vertebra (L3) level was measured using CT， and the L3-SMI was calculated. Patients were classified into sarcopenia and non-sarcopenia groups based on gender-specific cutoff values L3-SMI. The clinicopathological features， therapeutic efficacy and survival were compared between the two groups， and their relation with L3-SMI was analyzed. ［Results］ Among 153 patients， 31 (20.3%) were diagnosed with sarcopenia. Compared with non-sarcopenia group， sarcopenia group was associated with more adverse clinical features， including B symptoms， extranodal involvement sites ≥2， advanced stage (Ⅲ~Ⅳ)， higher international prognostic index(IPI) and Eastern Cooperative Oncology Group (ECOG) scores， and lower body mass index (all P<0.05)； the sarcopenia group exhibited a higher disease progression rate(17.2% vs 32.3%)， lower complete response rate (57.4% vs 35.5%)， and lower 5-year overall survival (OS) rate (65.2% vs 43.7%) (all P<0.05). Multivariate analysis showed that decreased L3-SMI， increased lactate dehydrogenase(LDH) and albumin (ALB) <40 g/L were independent risk factors for OS in male patients. In male patients， the 5-year OS of sarcopenia group and non-sarcopenia group were 32.3% and 62.3%， respectively (P=0.006)， and the 5-year OS of patients with elevated LDH or ALB <40 g/L in the sarcopenia group and the non-sarcopenia group were 0 vs 51.5% (P=0.006) and 11.4% vs 48.0% (P=0.027)， respectively.［Conclusion］ Sarcopenia defined by L3-SMI may serve as an important prognostic indicator in DLBCL patients (especially for male patients). Male DLBCL patients presenting with sarcopenia， especially those with elevated LDH or decreased ALB levels require more individualized treatment. |
|
在线阅读
查看全文 查看/发表评论 下载PDF阅读器 |