原发中枢神经系统淋巴瘤临床病理特征及其对预后的影响  

Clinicopathological Features of Primary Central Nervous System Lymphoma and Their Influence on Prognosis of Desease

作　　者：杜朝阳[1] 杨如玉[1] 李超[1] 段丽娟[1] 

机构地区：[1]河南省南阳市中心医院血液科,河南南阳473001

出　　处：《中国实验血液学杂志》2016年第6期1776-1781,共6页Journal of Experimental Hematology

摘　　要：目的:研究原发中枢神经系统淋巴瘤(PCNSL)的临床特征及其对预后的影响。方法:选取我院2012年1月至2015年12月住院部确诊为PCNSL的患者42例,对所有患者均进行了实验室检查、影像学检查、骨髓检查及病理检查,给予26例进行甲氨蝶呤联合腰穿鞘给药治疗,8例进行甲氨蝶呤联合利妥昔单抗治疗,8例确诊为PCNSL后自愿放弃治疗。结果:12例患者头痛,2例复视,6例头晕,10例肢体无力,2例失忆,4例语言不利;4例为外周T细胞淋巴瘤,38例B细胞淋巴瘤;30例多发性病灶,12例单发性病灶,胼胝体8例,丘脑8例,额叶8例,顶叶、颞叶、丘脑等均出现少数病变,2例脑积水,2例脑出血;所有患者HIV检查均为阴性,8例血沉速度增快,42例患者IgG、IgE及IgM水平均有不同程度的上升,血常规、肝功能及血凝系统正常;腰椎注射、甲氨蝶呤剂量、放射治疗、造血干细胞移植对生存时间影响差异无统计学意义(P>0.05),联合利妥昔单抗和病灶数对生存时间影响差异有统计学意义(P<0.05);年龄和脑脊液中蛋白含量对疗效的差异有统计学意义(P<0.05)。结论:PCNSL的影像学检查结果、临床表现与其他颅内肿瘤无明显差别,腰穿术是有效鉴别途径,年龄、脑脊液蛋白及病灶数目是影响预后的不良因素。Objective：To study the clinical features of of patients with primary central nervous system lymphoma（PCNSL） and their influence on prognosis.Methods：Forty- two cases of PCNSL hospitallized in our hospital from January 2012 to December 2015 were selected,and the laboratory analysis,imaging examination,bone marrow analysis and pathological examination all were performed,26 cases were treated by lumbar puncture combined with intrathecal injection of drugs（Ara C,dexamethason and methotrexate）,8 cases were treated by methotrexate combined with rituximab,8 cases voluntanly abandon treatment after being diagnosed as PCNSL.Results：Headache accrued in 12 cases,diplopia in 2 cases,dizziness in 6 cases,limb weakness in 10 cases,amnesia in 2 cases,inhibited speech in 4cases.Out of 42 patients 4 cases of peripheral T cell lymphoma,38 cases of B cell lymphoma;30 cases of multiple lesions,12 cases of solitary lesions,8 cases of corpus callosum,8 cases of thalamus,8 cases of frontal lobe,parietal lobe,temporal lobe,thalamus and other lesions,2 cases of hydrocephalus,2 cases of cerebral hemorrhage;and the patients HIV were negative.8 cases erythrocyte sedimentation rate were faster,IgG,IgE and IgM levels increased to varying degrees in 42 cases,and the blood routine,liver function and blood coagulation examinations showed normal;There was no significant difference in the influence of the lumbar injection,methotrexate dose,radiation therapy,and hematopoietic stem cell transplantation on survival time（P〉0.05）;but there was significant difference in the influence of rituximab and number of lesions on survival time（P〈0.05）;there were significant differences in the effects of age and protein content in cerebro spinal fluid on therapeutic effecacy（P〈0.05）.Conclusion：There is no significant difference in the imaging examination and clinical manifestation between PCNSL and other intracranial tumors.The lumbar puncture is an effective way to identify,the age,cerebrospinal fluid protein and the number of l

关 键 词：原发性中枢神经系统淋巴瘤 预后影响 临床特征 

分 类 号：R733.1[医药卫生—肿瘤]