中枢神经系统血管内淋巴瘤1例临床分析并文献复习  

Clinical analysis of a case with central nervous system-intravascular lymphoma and literature review

作　　者：刘春光 李芬[2] 赖敏 邓兵[4] 王用书 吕涛[4] 徐学君[4] Liu Chunguang;Li Fen;Lai Min;Deng Bing;Wang Yongshu;Lyu Tao;Xu Xuejun(Department of Emergency,Daping Hospital,Army Medical University,Chongqing 400042,China;Department of Pathology,Chengdu Second People′s Hospital,Chengdu 610021,Sichuan Province,China;Intensive Care Unit of Chengdu Public Health Clinical Medical Center,Chengdu 610066,Sichuan Province,China;Department of Neurosurgery,Chengdu Second People′s Hospital,Chengdu 610021,Sichuan Province,China)

机构地区：[1]陆军军医大学(大坪医院)急诊医学科,重庆400042 [2]成都市第二人民医院病理科,成都610021 [3]成都市公共卫生临床医疗中心重症监护室,成都610066 [4]成都市第二人民医院神经外科,成都610021

出　　处：《国际输血及血液学杂志》2023年第4期336-345,共10页International Journal of Blood Transfusion and Hematology

基　　金：成都市重大科技应用示范项目(2019-YF09-00097-SN)。

摘　　要：目的探讨中枢神经系统(CNS)-血管内淋巴瘤(IVL)患者的临床特点、实验室检查结果及诊治方法,并进行相关文献复习。方法选择2021年12月19日成都市第二人民医院神经外科收治的1例54岁CNS-IVL男性患者为研究对象。采用回顾性分析方法,对其既往病史,临床表现,实验室检查、影像学检查、宏基因二代测序(mNGS)结果等临床资料进行分析。依据临床特征和相关检查结果,对患者进行诊断和治疗。本研究以"血管内淋巴瘤""弥漫大B细胞淋巴瘤""脊髓内出血""中枢神经系统""脊髓""intravascular lymphoma""diffuse large B-cell lymphoma""intraspinal hemorrhage""central nervous system""spinal cord"为中、英文关键词,检索中国知网数据库、万方数据知识服务平台及PubMed数据库中相关文献,总结与本研究累及脊髓CNS-IVL患者相关疾病的诊治资料。文献检索时间为建库至2022年3月1日。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求,并与患者及患者家属签署临床研究知情同意书。结果①本例患者因"左上肢麻木、无力10 d"入院。既往有结核性脑膜炎、病毒性脑膜炎、肝功能不全、重症肺炎及红皮病病史。②入院时本例患者血常规检查结果示,白细胞计数(WBC)、中性粒细胞百分数、红细胞计数、血红蛋白(Hb)值、血小板计数分别为5.4×10^(9)/L、72.5%、3.02×10^(12)/L、87 g/L、49×10^(9)/L。腹部彩色多普勒超声检查结果示,脾轻度增大。头部MRI、磁共振血管成像(MRA)、磁敏感加权成像(SWI)检查结果示,双侧额叶、左侧顶叶、基底节区腔隙性脑梗死及缺血灶;脑萎缩,脑白质脱髓鞘改变;颅内动脉走行、侧支循环正常;右侧颞叶及侧脑室旁少许微出血灶。脊柱MRI检查结果示,颈段脊髓明显水肿,其内见斑片状低信号影,考虑脊髓内出血。患者接受颈段脊椎全椎板入路髓内病损切除和椎板复位内固定手�Objective To investigate the clinical characteristics,laboratory findings,diagnosis and treatment of patients with central nervous system(CNS)-intravascular lymphoma(IVL),and review the related literature.Methods On December 19,2021,a case of a 54 year-old male patient with CNS-IVL admitted to Neurosurgery Department of Chengdu Second People′s Hospital was selected as the study subject.A retrospective analysis method was used to analyze the patient′s clinical data such as medical history,clinical manifestations,laboratory tests,imaging examinations,metagenomic next-generation sequencing(mNGS)results.Diagnose and treatment of this patient based on clinical manifestations and related examination results.China National Knowledge Infrastructure database,Wanfang Data Knowledge Service Platform and PubMed database were searched using"intravascular lymphoma","diffuse large B-cell lymphoma","intraspinal hemorrhage","central nervous system","spinal cord"as Chinese and English keywords.Diagnosis and treatment data of CNS-IVL involving spinal cord was summarized.The time for literature retrieval was from inception of the database to March 1,2022.Procedure followed in this study was in line with requirements of the World Medical Association Declaration of Helsinki revised in 2013,and informed consent of clinical research was signed with the patient and his family members.Results①This patient was admitted due to"numbness and weakness in the left upper limb for 10 d".Previous history of the patient included tuberculous meningitis,viral meningitis,liver dysfunction,severe pneumonia and erythroderma.②At the time of admission,blood routine test results of this patient showed that white blood cell count(WBC),neutrophil percentage,red blood cell count,hemoglobin(Hb)value,platelet count were 5.4×10^(9)/L,72.5%,3.02×10^(12)/L,87 g/L,49×10^(9)/L,respectively.Abdominal color Doppler ultrasound shows mild enlargement of the spleen.Results of cranial MRI,magnetic resonance angiography(MRA),and susceptibility weighted imaging(S

关 键 词：淋巴瘤 大B细胞 弥漫性 中枢神经系统 疱疹病毒4型 人 血管内淋巴瘤 脊髓内出血 

分 类 号：R739.4[医药卫生—肿瘤]