肺淋巴瘤患者的临床特征分析  

Clinical Analysis of Pulmonary Lymphoma

作　　者：李丽 韩旗[2] 顾岩 葛峥 LI Li;HAN Qi;GU Yan;GE Zheng(School of Clinical Medicine,Nanjing Medical University,Nanjing 211166,Jiangsu Province,China;Department of Hematology,Zhongda Hospital,Southeast University,Nanjing 210009,Jiangsu Province,China;Department of Respiration,Zhongda Hospital,Southeast University,Nanjing 210009,Jiangsu Province,China)

机构地区：[1]南京医科大学临床医学院,江苏南京211166 [2]东南大学附属中大医院血液科,江苏南京210009 [3]东南大学附属中大医院呼吸科,江苏南京210009

出　　处：《中国实验血液学杂志》2023年第1期109-114,共6页Journal of Experimental Hematology

基　　金：国家自然科学基金面上项目(81770172);江苏省“333工程”项目(BRA2019103);江苏省医学重点学科(ZDXKB2016020)。

摘　　要：目的:分析肺淋巴瘤患者的临床表现、影像学特征及病理类型。方法:收集东南大学附属中大医院2013年11月至2020年12月经肺部活检病理确诊为肺淋巴瘤的病例,按照淋巴瘤的原发部位分为原发性肺淋巴瘤(PPL)和继发性肺淋巴瘤(SPL)两组,分析两组患者临床表现、分期、影像学特征、诊断方法及病理类型。结果:共纳入22例,PPL 10例,SPL 12例。两组患者临床表现均以咳嗽、呼吸困难和胸痛为主,SPL组III/IV期患者比例及国际预后指数显著高于PPL组(P<0.05)。两组患者胸部高分辨电子计算机断层扫描(HRCT)表现均以肿块、结节、实变为主,PPL组表现为单发肿块及支气管充气征的比例显著高于SPL组,表现为多发结节、纵隔/肺门淋巴结肿大以及胸腔积液的比例显著低于SPL组(P<0.05)。PPL组18F-脱氧葡萄糖(18F-FDG)正电子发射断层显像/计算机断层扫描(PET/CT)的相关参数——最大标准化摄取值(SUV_(max))、标准化摄取值峰值(SUV_(peak))、代谢肿瘤体积(MTV)及总病变糖酵解(TLG)低于SPL组,但比较差异无统计学意义(P>0.05)。PPL组8例经支气管肺活检(TBLB)确诊,2例经皮肺穿刺确诊。SPL组4例行TBLB确诊,7例行经皮肺穿刺确诊,1例通过外科手术确诊,所有患者中非手术方式确诊的比例为95.5%。PPL病理类型以黏膜相关淋巴组织淋巴瘤为主,而SPL以弥漫大B细胞淋巴瘤为主(P<0.05)。结论:肺淋巴瘤的症状无特异性,胸部HRCT有特征性表现,且胸部HRCT可以协助鉴别SPL和PPL,18F-FDG PET/CT也是鉴别SPL与PPL的潜在方法。TBLB及经皮肺穿刺活检是确诊肺淋巴瘤的可靠手段。PPL病理类型以黏膜相关淋巴组织淋巴瘤为主,而SPL以弥漫大B细胞淋巴瘤为主。Objective:To study the clinical,imaging,and pathological features of pulmonary lymphoma.Methods:Patients with pulmonary lymphoma diagnosed by lung biopsy in Zhongda Hospital Affiliated to Southeast University from November 2013 to December 2020 were collected and divided into secondary pulmonary lymphoma (SPL) group and primary pulmonary lymphoma (PPL) group according to the primary site of lymphoma.The clinical characteristics,stages,imaging features,diagnostic methods and pathological types of the two groups were analyzed.Results:A total of 22 patients were included,10 cases were PPL and 12 cases were SPL.The main symptoms of the two groups were cough,dyspnea and chest pain.The proportion of stage III/IV patients and international prognostic index (IPI) in SPL group were significantly higher than those in PPL group (P<0.05).Chest high-resolution computed tomography (HRCT) mainly showed masses,nodules and consolidation in both groups.The proportions of single mass and air bronchial sign in PPL group were significantly higher than those in SPL group,while the proportions of multiple nodules,mediastinal/hilar lymphadenopathy and pleural effusion were significantly lower (P<0.05).The max standardized uptake value (SUV_(max)),peak standardized uptake value (SUV_(peak)),total lesion glycolysis (TLG) and metabolic tumor volume (MTV) of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in PPL group were lower than those in SPL group,but the differences were not statistically significant (P>0.05).In PPL group,8 cases were diagnosed by transbronchial lung biopsy (TBLB) and 2 cases by percutaneous lung puncture.In SPL group,4 cases were diagnosed by TBLB,7 cases by percutaneous lung puncture,and 1 case by surgery.95.5%patients were diagnosed by non-surgical methods.The main pathological type of PPL was mucosa-associated lymphoid tissue (MALT) lymphoma,while that of SPL was diffuse large B-cell lymphoma (P<0.05).Conclusion:The clinical symptoms of pulmonary lymphoma are nonspecific,

关 键 词：肺淋巴瘤 临床特征 影像特征 

分 类 号：R733[医药卫生—肿瘤] R734.2[医药卫生—临床医学]