CAJ | 학술논문

目的：探讨乙型肝炎病毒（HBV）感染与多发性骨髓瘤（MM）发病之间的关系，为MM的防治提供流行病学依据。方法：收集2010年10月至2014年10月西安市中心医院、陕西省人民医院、西安市交通大学西北医院等5所三级甲等医院185例新发MM患者的临床和实验室资料，随机选择在年龄和性别上匹配的同期住院非肿瘤患者作为对照。采用ELISA法检测外周血HBsAg；对于HBsAg阴性者，采用巢式PCR扩增检测HBV DNA的S、C区基因。用SPSS 16.0统计学软件进行组间的差异比较；HBV与MM发病之间的关系采用Logistic回归分析。结果：MM患者的HBsAg阳性率为8.11%（15/185），隐匿性HBV感染（occult hepatitis B virus infection，OBI）阳性率为3.53%（6/170），HBV的总感染率为11.35%（21/185）；对照组的HBsAg阳性率为4.40%（8/182），OBI阳性率为0.57%（1/174），HBV的总感染率为4.95%（9/182）。两组HBsAg和OBI阳性率的差异均无统计学意义（P>0.05），但MM患者HBV总感染率显著高于对照组（χ2=5.02，P<0.05）；其OR值为2.46（95%CI：1.10～5.53），P<0.05。另外，HBV感染者Ⅲ期MM所占比例明显高于未感染者（85.71%vs.60.37%，χ2=5.15，P<0.05）；血白蛋白水平在HBV感染者中较未感染者明显减低（χ2=5.60，P<0.05），κ/λ轻链比值在HBV感染者中明显低于未感染者（P<0.05）。结论：将OBI纳入分析后，感染HBV发生MM的风险较未感染者明显增高；伴有HBV感染的MM患者肝脏损害更为严重，建议对HBsAg阴性的MM患者在化疗前开展OBI筛查，以预防出现HBV再激活而影响生存期。
목적：탐토을형간염병독（HBV）감염여다발성골수류（MM）발병지간적관계，위MM적방치제공류행병학의거。방법：수집2010년10월지2014년10월서안시중심의원、합서성인민의원、서안시교통대학서북의원등5소삼급갑등의원185례신발MM환자적림상화실험실자료，수궤선택재년령화성별상필배적동기주원비종류환자작위대조。채용ELISA법검측외주혈HBsAg；대우HBsAg음성자，채용소식PCR확증검측HBV DNA적S、C구기인。용SPSS 16.0통계학연건진행조간적차이비교；HBV여MM발병지간적관계채용Logistic회귀분석。결과：MM환자적HBsAg양성솔위8.11%（15/185），은닉성HBV감염（occult hepatitis B virus infection，OBI）양성솔위3.53%（6/170），HBV적총감염솔위11.35%（21/185）；대조조적HBsAg양성솔위4.40%（8/182），OBI양성솔위0.57%（1/174），HBV적총감염솔위4.95%（9/182）。량조HBsAg화OBI양성솔적차이균무통계학의의（P>0.05），단MM환자HBV총감염솔현저고우대조조（χ2=5.02，P<0.05）；기OR치위2.46（95%CI：1.10～5.53），P<0.05。령외，HBV감염자Ⅲ기MM소점비례명현고우미감염자（85.71%vs.60.37%，χ2=5.15，P<0.05）；혈백단백수평재HBV감염자중교미감염자명현감저（χ2=5.60，P<0.05），κ/λ경련비치재HBV감염자중명현저우미감염자（P<0.05）。결론：장OBI납입분석후，감염HBV발생MM적풍험교미감염자명현증고；반유HBV감염적MM환자간장손해경위엄중，건의대HBsAg음성적MM환자재화료전개전OBI사사，이예방출현HBV재격활이영향생존기。
Objective:To explore the relationship between hepatitis B virus (HBV) infection and the pathogenesis of multiple my-eloma (MM), in order to provide an epidemiological evidence for the prevention and treatment of MM. Methods:Clinical and epidemi-ological data of 185 MM patients and 182 non-tumorous patients were collected. Subjects were randomly selected from in-patients who were homeochronously admitted to the same five grade-III A hospitals, including Xi'an Central Hospital, Shaanxi People's Hospital, Xi'an Jiaotong University Xibei Hospital, and so on. MM patients were selected in terms of age and gender. Peripheral blood HBsAg was assayed by ELISA. If HBsAg was negative, the S and C-gene fragments of HBV DNA were tested using nested PCR . Fisher's ex-act test orχ2 test (SPSS statistical software) was used to compare the differences between the groups. Logistic regression was employed to examine the association between the pathogenesis of MM and HBV infection. Results:In MM patients, the HBsAg positive rate was 8.11% (15/185), the occult HBV infection (OBI) positive rate was 3.53% (6/170), and the total HBV infection rate was 11.35% (21/185). For the control group, the HBsAg positive rate was 4.40%(8/182), the OBI positive rate was 0.57%(1/174), and the total HBV in-fection rate was 4.95%(9/182). No statistical difference in HBsAg or OBI positive rate was found between the two groups (P>0.05). However, MM patients showed significantly higher total HBV infection rate than that of the controls [χ2=5.02, P<0.05;OR was 2.46 (95%CI:1.10-5.53, P<0.05)]. Additionally, the proportion of ISS stage III was significantly higher in MM patients with HBV infection than in uninfected MM patients (85.71%vs. 60.37%,χ2=5.15, P<0.05). Patients with HBV infection showed reduced albumin level (χ2=5.60, P<0.05) and aκ/λlight chain ratio (P<0.05) compared with uninfected patients. Conclusion:The risk of MM pathogenesis after HBV infection is significantly increased as OBI is included in the analyses. Furthermore, MM patients with HBV infection will develop more severe liver damage, indicating that OBI in MM patients with negative HBsAg should be screened before chemotherapy to pre-vent HBV reactivation.