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目的:分析B细胞非霍奇金淋巴瘤(B cell non-Hodgkin’s lymphoma,B-NHL)患者行化疗或免疫化疗后发生间质性肺炎(interstitial pneumonia,IP)与美罗华(利妥昔单抗注射液)的相关性,并分析IP发生的临床特征。方法:回顾性分析天津医科大学肿瘤医院2010年1月至2015年5月期间266例初治CD20~+B-NHL患者的病例资料,将所有病例分为美罗华联合化疗组和单纯化疗组,分析IP的发生与美罗华使用之间的关系,及其相关的临床特点。结果:化疗联合美罗华组中IP的发生率9.6%(13/135)较单纯化疗组2.3%(3/131)高(P<0.05),与IP发生相关的临床特征包括老年、男性、初诊时淋巴细胞计数高于正常值、既往糖尿病史、病理亚型为弥漫性大B细胞性淋巴瘤(diffuse large B-cell lymphoma,DLBCL);淋巴细胞绝对值超过正常范围(HR=14.685,95%CI:3.137~63.234,P=0.001)、糖尿病(HR=8.811,95%CI:1.907~40.720,P=0.005)、病理亚型为DLBCL(HR=0.078,95%CI:0.012~0.489,P=0.006)及美罗华的使用(HR=6.769,95%CI:1.359~33.710,P=0.020)是其发生的独立危险因素。多数患者无明显症状,不需要特殊处理。结论:美罗华可导致IP的发生,可能与免疫力的降低及真菌感染相关,激素冲击疗法联合或不联合抗真菌治疗能取得良好的疗效。
Objective: To analyze the relationship between interstitial pneumonia (IP) and rituximab in patients with B cell non-Hodgkin’s lymphoma (B-NHL) after chemotherapy or immunotherapy. Fluid), and analyzed the clinical features of IP. Methods: A retrospective analysis of 266 cases of newly diagnosed CD20 ~ + B-NHL patients from Tumor Hospital of Tianjin Medical University between January 2010 and May 2015 was conducted. All patients were divided into two groups: rituximab combined chemotherapy group and chemotherapy alone group. The relationship between the occurrence of IP and the use of rituximab and its associated clinical features. Results: The incidence of IP in chemotherapy plus rituximab was 9.6% (13/135) higher than 2.3% (3/131) in chemotherapy alone group (P <0.05). The clinical features associated with IP included the elderly, males, Lymphocyte counts were higher than normal with a history of previous diabetes and the pathologic subtype was diffuse large B-cell lymphoma (DLBCL); lymphocyte absolute values exceeded the normal range (HR = 14.685, 95% CI (HR = 8.811, 95% CI: 1.907 ~ 40.720, P = 0.005). The pathological subtype was DLBCL (HR = 0.078, 95% CI: 0.012-0.489, P = 0.006) ) And rituximab (HR = 6.769, 95% CI: 1.359-33.710, P = 0.020) were independent risk factors for their occurrence. Most patients no obvious symptoms, do not need special treatment. Conclusion: Rituximab can cause the occurrence of IP, which may be related to the decrease of immunity and fungal infection. Hormone impact therapy can achieve good effect with or without antifungal therapy.