30例成熟NK细胞淋巴瘤骨髓侵犯患者的临床特点及实验室检查特征  

Clinical and laboratory detection features of 30 patients with mature NK cell lymphoma bone marrow invasion

作　　者：陶廷露 邓小娟 张云 杨武晨 张曦 彭显贵 TAO Tinglu;DENG Xiaojuan;ZHANG Yun;YANG Wuchen;ZHANG Xi;PENG Xiangui(Hematology Medical Center,Second Affiliated Hospital of Army Military Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院血液病医学中心,重庆400037

出　　处：《重庆医学》2022年第23期4008-4013,共6页Chongqing medicine

基　　金：重庆市科卫联合医学科研项目(2021MSXM140);重庆市社会事业与民生保障科技创新专项(cstc2017shmsA130003)。

摘　　要：目的通过分析成熟自然杀伤细胞(NK细胞)淋巴瘤骨髓侵犯的临床特点及实验室检查特征,探讨成熟NK淋巴瘤骨髓侵犯的临床诊断依据。方法回顾性分析2015年1月至2021年1月该中心收治的30例成熟NK淋巴瘤骨髓侵犯[包括侵袭性NK细胞白血病(ANKL)8例,结外NK/T细胞淋巴瘤和鼻型NK/T淋巴瘤(ENKTL-NT)16例,慢性NK细胞淋巴组织增生性疾病(cLPD-NK)6例]患者的临床特点、血象、骨髓细胞形态学及流式免疫表型。外周血标本通过血细胞分析仪进行血象检查。骨髓涂片经瑞氏-吉姆萨染色分类计数,并根据瘤细胞形态特征及分化程度进行归类。采用多参数流式细胞仪对收集病例的淋巴瘤细胞比例及免疫表型进行分析。结果大多数ANKL、ENKTL-NT患者临床表现及血象相似,难以鉴别。而cLPD-NK患者多为惰性临床过程,且白细胞(WBC)水平常增高。ANKL患者瘤细胞多以原幼细胞型为主,ENKTL-NT患者瘤细胞以单核细胞型为主,原幼细胞型也可见;cLPD-NK患者以成熟小细胞型为主。ANKL患者CD57、CD7表达较低,ENKTL-NT、cLPD-NK患者高表达,差异均有统计学意义(P<0.05)。诊断成熟NK淋巴瘤骨髓侵犯时流式细胞术的阳性率高于骨髓细胞形态学,差异有统计学意义(P<0.05)。结论成熟NK淋巴瘤骨髓侵犯患者早期临床表现不明显。WBC增高可作为诊断cLPD-NK患者的参考,NK细胞淋巴瘤不同亚型的形态学改变明显。多技术联合诊断能有效提高NK细胞淋巴瘤诊断率和不同类型的鉴别能力,为NK细胞淋巴瘤的临床诊治提供科学的参考依据。Objective To investigate the clinical diagnosis basis of bone marrow invasion in mature natural killer(NK)cell lymphoma by analyzing its clinical and laboratory characteristics.Methods The clinical characteristics,hemogram,bone marrow cell morphology and flow immunophenotype of 30 cases of bone marrow invasion[including 8 cases of aggresive NK cell leukemiua(ANKL),16 cases of extranodal NK/T cell lymphoma and nasal type NK/T lymphoma(ENKTL-NT),6 cases of chronic NK cell lymphoproliferative disease(cLPD-NK)]treated in this center from January 2015 to January 2021 were retrospectively analyzed.Peripheral blood samples were examined by blood test instrument.The bone marrow smears were classified and counted by Wright Giemsa staining,and classified according to the morphological characteristics and differentiation degree of tumor cells.The proportion of lymphoma cells and immunophenotype were analyzed by the multiparameter flow cytometry.Results Most ANKL and ENKTL-NT patients had similar clinical manifestation and hemogram,which was difficult to distinguish.However,most of cLPD-NK patients had indolently clinical process,moreover the level of white blood cells(WBC)often was increased.Most of the tumor cells in ANKL patients were mainly primitive cell type,and the tumor cells in ENKTL-NT patients were mainly monocyte type,and the protoblastic type was also visible;the cLPD-NK patients were dominated by mature small cell type.The expression levels of CD57 and CD7 were lower in ANKL patients and higher in ENKTL-NT and cLPD-NK patients,and the differences were statistically significant(P<0.05).The positive rate of flow cytometry in diagnosing bone marrow invasion was higher than that of bone marrow cell morphology(P<0.05).Conclusion The early clinical manifestation of the bone marrow invasion patients with mature NK cell lymphoma is not obvious.WBC increase could be used as a reference for the diagnosis of cLPD-NK patients.Different subtypes of NK cell lymphomas have obvious morphological changes.The combined diagnosis

关 键 词：自然杀伤细胞淋巴瘤 骨髓侵犯 流式细胞术 骨髓细胞形态学 

分 类 号：R714.254[医药卫生—妇产科学]