原发性骨弥漫大B细胞淋巴瘤合并肺结核诊治分析  

Diagnosis and treatment of primary bone diffuse large B-cell lymphoma complicated with pulmonary tuberculosis

作　　者：刘妍丽[1,2] 吴思静[2] 杨时佳 李登举[2] 

机构地区：[1]武汉市结核病防治所,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院血液科,湖北武汉430030

出　　处：《中华医院感染学杂志》2014年第21期5336-5338,共3页Chinese Journal of Nosocomiology

基　　金：湖北省自然科学基金资助项目(2013CFB075)

摘　　要：目的探讨原发性骨弥漫大B细胞淋巴瘤合并肺结核患者的诊断和鉴别诊断,分析淋巴瘤治疗过程中结核复燃和乙型肝炎病毒再激活的可能性。方法回顾性分析1例骨原发性弥漫大B细胞淋巴瘤患者的诊治经过,以及合并肺结核与乙型肝炎病毒的处理。结果原发性弥漫大B细胞淋巴瘤通过骨活检证实,而合并存在的肺结核最初由正电子发射计算机断层显像(PET)-CT检查误诊为淋巴瘤胸膜转移,后经CT引导下组织活检证实,避免了临床的误诊和误治;应用利妥昔单抗联合化疗治疗淋巴瘤同时,未出现结核播散和乙型肝炎病毒再激活;抗结核药物与化疗药物同时应用未出现肝功能损害的持续加重,随访无淋巴瘤未复发。结论病理组织检查对原发性骨淋巴瘤(primary bone lymphoma,PBL)的确诊至关重要,PBL诊治过程中需关注特殊感染的合并存在以及对原发病诊治的影响,PET-CT检查结果分析需结合临床和病理进行判断。OBJECTIVE To observe the diagnosis and differential diagnosis of primary bone diffuse large B-cell lym-phoma with concurrent pulmonary tuberculosis and analyze the possibilities of the resurgence of tuberculosis and the reactivation of hepatitis B virus .METHODS The clinicopathological features of one case of primary bone diffuse large B-cell lymphoma and the treatment outcomes of complication of pulmonary tuberculosis and hepatitis B virus were retrospectively analyzed .RESULTS The primary bone diffuse large B-cell lymphoma was conformed through bone biopsy ,while the concurrent pulmonary tuberculosis was initially misdiagnosed as lymphoma pleural metasta-sis by the positron emission tomography （PET ）-CT examination but was then confirmed through the CT-guided tissue biopsy ,and the clinical misdiagnosis and mistreatment were avoided .The dissemination of tuberculosis and the reactivation of hepatitis B virus have not emerged since the rituximab combined with chemotherapy was per-formed for treatment of lymphoma .The use of anti-TB drugs and chemotherapeutic drugs at the same time did not aggravate the damage of liver function ,and the follow-up found no case of recurrence of lymphoma .CONCLUSION The pathological biopsy is essential for the diagnosis of primary bone lymphoma （PBL）;great attention should be paid to the concurrent special infections as well as the influence on diagnosis and treatment of primary diseases , and the results of PET-CT examination need to be interpreted with the combination of the clinicopathological features .

关 键 词：骨淋巴瘤 肺结核 乙型肝炎病毒 利妥昔单抗 

分 类 号：R733.4[医药卫生—肿瘤]