原发性小肠淋巴瘤的临床、内镜特征及预后相关因素分析  

Clinical and endoscopic features,and prognostic factors of primary small intestinal lymphoma

作　　者：陈晓 王雷 范崇熙 李曼华 李静 宁守斌 李白容 CHEN Xiao;WANG Lei;FAN Chongxi;LI Manhua;LI Jing;NING Shoubin;LI Bairong(Department of Gastroenterology,Air Force Medical Center,Air Force Medical University,PLA,Beijing 100142,China)

机构地区：[1]空军军医大学空军特色医学中心消化内科,北京100142

出　　处：《空军航空医学》2024年第5期411-416,共6页AVIATION MEDICINE OF AIR FORCE

基　　金：首都卫生发展科研专项(2020-4-5123)。

摘　　要：目的通过分析原发性小肠淋巴瘤的临床、内镜特征及预后相关因素,提高其诊断效率为疾病预后评估提供依据。方法回顾性分析空军特色医学中心2008年1月—2022年11月小肠镜下发现病变且病理明确诊断为原发性小肠淋巴瘤患者的临床资料、内镜下表现、诊断后评估治疗经过和预后。总结并比较不同病理类型和不同影像分期(进展期和局限期)的原发性小肠淋巴瘤患者的临床表现、内镜特点及诊断后生存曲线,并对不良预后(死亡)的预测因素进行Cox生存分析。结果纳入33例有随访结果的原发性小肠淋巴瘤患者进行分析,平均年龄为(55.8±1.6)岁;临床表现主要为腹痛(75.8%)、消化道梗阻(48.6%)、消化道出血(39.4%)和消瘦(45.5%)。病理类型以B细胞来源淋巴瘤(28例,84.8%)为主,少部分为T细胞来源淋巴瘤(5例,15.2%);B细胞来源淋巴瘤包括弥漫大B细胞淋巴瘤17例(51.5%)、滤泡细胞淋巴瘤6例(18.2%)和黏膜相关淋巴组织(mucosaassociatedlymphoidtissue,MALT)淋巴瘤5例(15.2%)。弥漫大B细胞淋巴瘤内镜活检组织病理诊断率较高(>80%),而MALT淋巴瘤及T细胞来源淋巴瘤内镜活检组织病理诊断率相对较低。影像评估为进展期的患者相较于局限期患者死亡风险较高,2组的中位生存时间差异有统计学意义(P=0.013)。原发性小肠淋巴瘤患者死亡独立危险因素包括:诊断时合并中重度贫血(HR=6.377,95%CI:1.245~32.657,P=0.026)、病理类型为T细胞来源淋巴瘤(HR=24.694,95%CI:2.978~204.767,P=0.003)及影像学评估为进展期(HR=6.923,95%CI:1.871~25.620,P=0.004)。结论小肠镜检查并活检对小肠淋巴瘤确诊有重要价值,诊断时合并中重度贫血、影像进展期及T细胞来源淋巴瘤与不良预后相关。Objective To analyze the clinical and endoscopic features and prognostic factors of primary small intestinal lymphoma in order to improve the diagnostic efficiency and provide data for prognostic evaluation.Methods A retrospective analysis was conducted of the clinical data and endoscopic features of patients with primary small intestinal lymphoma who had accepted balloon-assisted enteroscopy(BAE)at our center between January 2008 and November 2022.Treatments and prognosis were evaluated after a detailed follow-up.The clinical manifestations and endoscopic features of small intestinal lymphoma patients were summarized according to pathological types and clinical stages.Also,the survival curve after diagnosis and poor prognosis(death)related factors were analyzed.Independent predictors of poor prognosis(death)were explored via the COX proportional-hazards model.Results Thirty-three patients with primary small intestinal lymphoma with follow-up results were included for analysis,with an average age of(55.8±1.6)years old.The clinical manifestations were abdominal pain(75.8%),gastrointestinal obstruction(48.6%),gastrointestinal bleeding(39.4%),and weight loss(45.5%).The pathological types of cases were B-cell lymphoma(28 cases,84.8%)and T-cell lymphoma(5 cases,15.2%).The former included 17 cases of diffuse large B-cell lymphoma(51.5%),6 cases of follicular cell lymphoma(18.2%),and 5 cases of mucosal associated lymphoid tissue lymphoma(MALT lymphoma)(15.2%).The diagnostic rate of endoscopic biopsy for B-cell lymphoma was relatively high(>80%),while the rate of pathological diagnosis of MALT lymphoma and T-cell lymphoma was reduced with BAE-biopsy.Patients with advanced imaging staging had a significantly higher risk of death,and there was significant difference in median survival time between the two groups of patients(P<0.05).Independent risk factors for death in patients with primary small intestinal lymphoma included moderate to severe anemia(HR=6.377,95%CI:1.245~32.657,P=0.026),T-cell lymphoma(HR=24.694,95%CI:2.9

关 键 词：小肠淋巴瘤 小肠镜 预后 危险因素 

分 类 号：R57[医药卫生—消化系统]