譯者：衛春 修改：梁美娥 審核：許珂
ABSTRACT：BACKGROUND: Patients with Sjögren's syndrome (SS) have a considerable higher risk of lymphoma development.OBJECTIVES: To determine the incidence of lymphoma and the value of biomarkers to predict lymphoma development in patients with SS.METHODS: Clinical files of all patients with a presumed diagnosis of SS between 1991 and 2016 were retrospectively reviewed for the development of lymphoma. Biochemical data were plotted as a function of the relative time before and after the lymphoma diagnosis (for patients who developed lymphoma) or before the last available blood test (for patients who did not develop lymphoma). Correlations between several biochemical parameters and development of lymphoma were analyzed by logistic regression. In order to evaluate the evolution of cryoglobulins, a random effect model with random intercepts was used.RESULTS: Sixteen patients developed a lymphoma (prevalence 8.9%; median follow- up 6 years). Cryoglobulins were significantly higher in these patients (n = 16), when compared to the rest of patients (n = 164) without lymphoma (121 ± 250 versus 8 ± 24.9 mg/L for IgG; 231 ± 422 versus 13 ± 30 mg/L for IgM; 10 ± 20 versus 1 ± 4 mg/L for IgA in the cryoprecipitate). Cryoglobulin- levels were significantly more increasing (pvalues for IgG = 0.0007; for IgM = 0.0123; and for IgA in the cryoprecipitate <0.0001) in the time period before the lymphoma diagnosis (patients with lymphoma) compared to the time period before the last available blood test (patients without lymphoma). Also low (i.e. under the detection limit) C3 (OR 13.9) or C4 (OR 7.1) levels, a progressively decreasing total complement activity (OR 6.6), progressively decreasing gammaglobulins (OR 13.4), a persistent detection of monoclonal bands (OR 14.6) on protein electrophoresis, a persistent low or decreasing serum IgG (OR 18), and decreasing IgMserum levels (OR 17.7) were significantly associated with lymphoma.CONCLUSION: Periodically followup of laboratory markers, such as cryogloblins, over time proved to be an accurate way to predict lymphoma.摘要：
背景：乾燥症候群（SS）患者有相當高的淋巴瘤發展風險。
目的：評估SS患者淋巴瘤發生率及生物標記物對淋巴瘤發展的預測價值。
方法：回顧性分析1991～2016年間所有診斷為SS患者的臨床資料。生化數據被繪製為淋巴瘤診斷前後（淋巴瘤患者）或在最後一次有效的血標本試驗之前（對於未發生淋巴瘤的患者）的相對時間。應用logistic回歸分析了多種生化指標與淋巴瘤發生的相關性。為評價冷球蛋白的進化，使用一個隨機效應模型進行攔截。
結果：十六名病人患了淋巴瘤（患病率為8.9%，中位隨訪6年）。相對於其餘無淋巴瘤的患者（n = 164），這些患者（n = 16）冷球蛋白均明顯升高（IgG: 121±250, 8±24.9 mg/L; IgM: 231±422, 13±30 mg/L; IgA: 10±20, 1±4 mg/L）。相對於最後一次有效的血標本測試前（患者無淋巴瘤），在確診淋巴瘤前（淋巴瘤患者）的冷球蛋白水平顯著增加（IgG: p= 0.0007; IgM: p= 0.0123; IgA: p＜0.0001）。此外，C3（13.9）或C4（7.1）的水平減低（即低於檢測限），總補體活性逐步降低（6.6），丙種球蛋白遞減（13.4），血清IgG持續降低（18），IgM水平降低（17.7），這些均與淋巴瘤的發生密切相關。
結論：定期監測實驗室指標，如血清免疫球蛋白、補體等，可有效預測淋巴瘤的發生、發展。
摘自：Kimman J1, Bossuyt X2, Blockmans D1. Prognostic value of cryoglobulins, protein electrophoresis, and serum immunoglobulins for lymphoma development in patients with Sjögren's syndrome. A retrospective cohort study. Acta Clin Belg. 2017 Oct 3:1-13. doi: 10.1080/17843286.2017.1373966.
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