中枢神经系统淋巴瘤临床诊治分析  

Central nervous system lymphoma and its significance

作　　者：郑文[1] 林宁晶[1] 谢彦[1] 王小沛[1] 涂梅峰[1] 刘卫平[1] 宋玉琴[1] 平凌燕 应志涛[1] 邓丽娟[1] 张晨[1] 朱军[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华医学杂志》2011年第22期1550-1554,共5页National Medical Journal of China

基　　金：首都医学发展科研基金（2009-3165）

摘　　要：目的探讨中枢神经系统淋巴瘤的发病、临床表现、诊断、治疗和预后。方法回顾性分析了2007年1月至2009年12月北京大学肿瘤医院收治的31例患者。采用SPSS16．0软件包进行统计。结果本组病例占我院同期收治的661例淋巴瘤的4．7％。男21例，女10例，中位年龄38岁。临床上主要表现为肿瘤侵犯所致的局灶性神经系统损害或颅内高压。以化疗为主的综合治疗，中枢神经系统淋巴瘤的完全缓解率为32．3％（10／31），部分缓解率为35．5％（11／31），总有效率为67．7％（21／31）。有中枢外或骨髓侵犯、高国际预后指数（IPI）评分、有B症状的患者疗效差（P〈0．05）。全组患者3、6、12、24个月的生存率分别为80．7％、74．2％、64．5％和58．1％，中位生存时间为22．5个月，Logistic单因素分析提示治疗是否有效与生存相关（OR=0．030，95％CI：0．003～0．270，P=0．000）。结论中枢神经系统淋巴瘤早期诊断困难，预后差，应寻求更有效的诊断手段和治疗方案。Objective To explore the clinical features, diagnosis, treatment and prognosis of central nervous system lymphoma （CNSL）. Methods Retrospective analysis was conducted for 31 CNSL cases from January 2007 to December 2009 in our hospital. Their clinical data were analyzed by statistical software package SPSS 16. 0. Results Accounting for around 4. 7% of all lympbomas at our institution, the present cohort had 21 males and 10 females with a median age of 38 years old. The major clinical manifestations were focal neurological deficits associated with the site of disease or increased intracranial pressure. Most patients were treated with chemotherapy-based regimens. The overall response rate was 67.7% （21/31） with 32. 3% （ 10/31 ） complete remission rate （CR） and 35.5% （ 11/31 ） partial remission rate （PR）. Involvement outside CNS or bone marrow, high international prognostic index （IPI） and B symptoms had significant effects on the therapeutic efficacy （ P 〈 0. 05 ）. The overall survival rates were 80. 7% ,74. 2% ,64. 5% and 58.1% at 3, 6, 12, 24 months respectively. The median survival time was 22. 5 months. Univariate analysis showed that the clinical efficacy had significant effects on the overall survival of patients（OR =0. 030,95% CI：O. 003 -0. 270,P =0. 000）. Conclusion The prognosis of CNSL remains poor. New diagnostic tools and treatment modality need to be explored.

关 键 词：淋巴瘤 中枢神经系统肿瘤 诊断 治疗 

分 类 号：R739.4[医药卫生—肿瘤]