Study The Relationship Between Laboratory Characteristics And Prognosis Of AIDS-related Diffuse Large B-cell Lymphoma

Objectives Analyzing the changes of EB virus,blood cytology,biochemistry and immunology in patients of AIDS-related diffuse large B-cell lymphoma who received anti-retroviral therapy(ART)combined with CHOP21/R-CHOP21 and studying the relationship between laboratory characteristics and prognosis of patients with AIDS-related diffuse large B-cell lymphoma,is going to provide a scientific basis for the diagnosis and treatment of patients with AIDS-related diffuse large B-cell lymphoma.Methods A two-way research method was used in this study.AIDS-related DLBCL patients were admitted to Yunnan Infectious Disease Hospital from January 2014 to June 2019 which following the inclusion rules,and be divided into EBV negative group(-)and EBV positive group(+)according to whether they were infected with EB virus.SPSS23.0 t test and Kaplan-Meier method were used to compare the hematology(HGB,NLR,PLR,LMR,FIB and D-D),liver function(T-Bil,ALT,AST,A/G and LDH),kidney function(UREA,CREA and UA)and lymphocyte count(CD4~+T,CD8~+T and CD4~+/CD8~+).Cox regression model was used to predict independent prognosis factorof these indictors.Use the Survival method in Graphpad Prism 8.0 to draw the survival curve of the above indicators.Results According to the inclusion and exclusion criteria,a total of 45 patients were enrolled in this study,including 15 in EBV(-)group and 30 in EBV(+)group,and all had completed at least 3 CHOP21/R-CHOP21 treatments.Among the enrolled patients,80.0%were male,mainly Han patients(80.0%),with an average age of 48.96±11.45years,and the average age in EBV(+)group was 49.30±11.61 years.1.The effect of CHOP21/R-CHOP21 on laboratory indicators(1)Hematology:Compared with before chemotherapy,the levels of hemoglobin(HGB)and neutrophil-to-lymphocyte ratio(NLR)in 45 AIDS-related DLBCL patients were significantly decreaed(P<0.001,P<0.001)after chemotherapy,and the ratio of lymphocyte to monocyte ratio(LMR)was significantly increased(P<0.001).There were no significant changes in the indicators between EBV(-)group and EBV(+)group(P>0.05).Patients in EBV(-)group had significantly lower HGB levels after chemotherapy(P=0.036),and LMR levels had significantly increased(P=0.024);patients in the EBV(+)group had significantly higher HGB and NLR levels after chemotherapy(P=0.002,P=0.001).The level of LMR after chemotherapy was significantly increased(P=0.001).(2)Coagulation function:There were no statistical significance in plasma fibrin(FIB)and D-dimer(D-D)levels after chemotherapy,between EBV(-)group and EBV(+)group.(3)Liver function:45 patients with DLBCL and EBV(+)group both showed significantly lower serum aspartate aminotransferase(AST)levels after chemotherapy(P=0.007,P=0.003).The ratio of serum albumin/globules protein(A/G)was significantly increased(P<0.001,P<0.001),and the differences were statistically significant.The serum lactate dehydrogenase(LDH)levels of 45 patients and patients in EBV(+)group were significantly lower after chemotherapy(P<0.001,P=0.001);and serum LDH levels in EBV(+)group after chemotherapy were higher than those of EBV(-)group,the difference was statistically significant(P=0.009).After chemotherapy,the serum A/G ratio level of EBV(-)group increased significantly(P=0.001).(4)Renal function:Compared with before chemotherapy,all 45 patients and patients in EBV(+)group exhibited decreased levels of serum urea(UREA)(P=0.032,P=0.027),creatinine(CREA)(P=0.017,P=0.026)and uric acid(UA)(P<0.001,P<0.001)levels significantly.There were no significant changes in renal indicators between EBV(-)and EBV(+)group.The level of serum UA in EBV(-)group were significantly decreased after chemotherapy(P=0.001).(5)Lymphocyte count:The CD8~+T level of 45 patients and EBV(+)group after chemotherapy was significantly decreased(P=0.043,P=0.043),and the CD4~+/CD8~+level was significantly increased(P=0.040,P=0.005).2.Survival analysis:The 1-year,3-year,and 5-year overall survival rates of 45AIDS-related DLBCL patients were 71.1%,59.4%,and 42.1%,respectively.Only between 1-year and 5-year overall survival rate,the difference was statistically significant(P=0.029).In the 1-year survival rate,the survival rate of EBV(+)group(60.0%)was significant lower than that of EBV(-)group(93.3%)(P=0.020),and there were no difference between 3-year and 5-year survival rates of the two groups.The overall survival time of EBV(+)group was significantly shorter than that of EBV(-)group(P=0.022),and the median survival time was 14 months and 27 months,respectively.In EBV infection,there were 14 patients who turned negative,and 16patients who continued to be positive/recurrent positive after chemotherapy,and the overall survival time of patients who turned negative after treatment was significantly longer than those who continued to be positive/recurrent positive(P<0.001),with a median survival time of 7 months and 22 months respectively).The impact of labrolatory indicators on survival time:we found that HGB,NLR,PLR,DD,AST,UREA,CREA,UA,LDH,and CD4~+T were statistically different in the comparison of overall survival times of 45 AIDS-DLBCL patients(P<0.05).While the overall survival time in groups of HGB,PLR,LMR,AST,UREA,CREA and CD4~+T were also statistically significant in EBV(+)group(P<0.05).The results of Cox regression analysisshowed that EB virus,anemia,NLR,PLR,UREA,and CD4~+T cell counts were independent prognostic factors for the prognosis of AIDS-related DLBCL patients.Conclusion(1)CHOP/R-CHOP and ART treatments improved some laboratory indicators of AIDS-DLBCL patients,such as improving anemia symptoms,decreasing LDH levels,enhancing liver and kidney function,and increasing lymphocyte count.(2)EBV,HGB,NLR,PLR,DD,AST,LDH,UREA,CREA,UA and CD4~+T are all related to the overall survival time of AIDS-related DLBCL patients.Among EBV(+)patients,anemia,lower LMR(<2.27),CD4~+T(<200 cells/m L)and higher NLR(>3),PLR(>150),AST(45U/L),UREA(>7.5mmol/L)and CREA(>80μmol/L)were predicting poor prognosis in patients with AIDS-DLBCL.(3)EBV,anemia,NLR,PLR,UREA and CD4~+T cell counts are independent prognostic factors for the prognosis of AIDS-related DLBCL patients,so they can be used as an important basis for disease monitoring and efficacy evaluation of EBV-positive AIDS-DLBCL.