原发性胃肠道淋巴瘤的临床特征和内镜特点分析  

The clinical features and endoscopic characteristics of primary gastrointestinal lymphoma

作　　者：邵琳琳[1] 朱思莹 邢洁[1] 武珊珊[1] 朱圣韬[1] 张澍田[1] Shao Linlin;Zhu Siying;Xing Jie;Wu Shanshan;Zhu Shengtao;Zhang Shutian(Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科,北京100050

出　　处：《首都医科大学学报》2022年第2期205-209,共5页Journal of Capital Medical University

基　　金：国家自然科学基金(81902472)。

摘　　要：目的探讨原发性胃肠道淋巴瘤(primary gastrointestinal lymphoma,PGIL)的临床特征和内镜特点,为临床医生提供诊疗依据。方法收集2015年1月至2021年8月在首都医科大学附属北京友谊医院经过病理组织学和免疫组织化学确诊PGIL的82例患者,其中男性45例,女性37例,中位发病年龄64岁。统计分析其一般资料、临床特征、内镜特点、病理类型及生存时间。结果82例患者中,胃淋巴瘤患者54例(65.9%),以累及两个部位(胃窦体)以上最常见,小肠淋巴瘤患者17例,(20.7%),结直肠淋巴瘤患者11例(13.4%)。PGIL的常见临床表现为腹痛/腹部不适、消化道出血、消瘦和消化不良。实验室检查显示,部分患者存在贫血和乳酸脱氢酶升高。PGIL的内镜下表现大多以溃疡性病变为主,也存在隆起性病变及浸润生长性病变;胃肠道黏膜受累时,以黏膜脆性增加最常见。在82例确诊PGIL的患者中,B细胞淋巴瘤最常见,共74例(90.2%),以弥漫性大B细胞性淋巴瘤(diffuse large B-cell lymphoma,DLBCL)最多见;共随访68例PGIL患者,胃淋巴瘤患者的5年累积生存率优于肠道淋巴瘤的患者。结论PGIL好发于中老年男性,以胃淋巴瘤最为常见,其中DLBCL是最常见的病理类型。溃疡性病变是PGIL的主要内镜下表现,且病变黏膜脆性增加,因此内镜医师应仔细辨认病变并多点活检,提高内镜诊断率。Objective To investigate the clinical features and endoscopic characteristics of primary gastrointestinal lymphoma(PGIL).Methods Clinical,endoscopic records and pathological results of PGIL diagnosed by histopathology and immunohistochemistry in Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University from January 2015 to August 2021 were retrospectively analyzed.Eighty-two patients were enrolled,including 45 males and 37 females,and the median age was 64 years old.Results Fifty-four patients were diagnosed with primary gastric lymphoma(PGL),accounting for 65.9%,and the lesions of most cases involved more than 2 sites.The cases of patients of small intestine lymphoma and colorectum lymphoma were 17 and 11,accounting for 20.7%and 13.4%,respectively.The clinical features were non-specific and varied in patients,of which abdominal pain/discomfort,gastrointestinal bleeding,weight loss and dyspepsia were prominent complains.Anemia and elevated lactate dehydrogenase were found within the blood test of some PGIL patients.Ulcerative lesions with increased brittleness were the most frequent endoscopic features for all the PGIL patients.Most of the pathological types were B cell lymphoma,and diffuse large B-cell lymphoma(DLBCL)was very common.The 5-year accumulate survival rate of gastric lymphoma was better than that of intestinal lymphoma.Conclusions PGIL was particularly prevalent in middle aged male,which was mainly represented with B cell lymphoma and diffuse large B-cell lymphoma was the most common histological subtype.Ulcerative lesions with increased brittleness were the most frequent endoscopic features.It is necessary for clinicians to repeat endoscopy for biopsy and identify the lesions to improve the accuracy of diagnosis.

关 键 词：原发性胃肠道淋巴瘤 临床特征 内镜特点 溃疡 

分 类 号：R735[医药卫生—肿瘤]