脑脊液指标对淋巴瘤中枢神经系统浸润的诊断价值

Diagnostic value of cerebrospinal fluid indexes in central nervous system infi ltration of lymphoma

目的通过分析高危组淋巴瘤患者的脑脊液等临床资料探讨脑脊液指标对于淋巴瘤中枢神经系统(central nervous system,CNS)浸润的诊断价值。方法回顾性分析2015年1月至2021年5月北部战区总医院收治的高危组行腰椎穿刺鞘注的92例淋巴瘤患者的临床资料和脑脊液指标。其中CNS浸润患者(CNS组)16例(17.4%)和非CNS浸润患者(non-CNS组)76例(82.6%)。比较两组患者的临床特征和脑脊液指标(包括颅内压力、蛋白定量、潘氏试验、有核细胞计数和淋巴瘤细胞等)。结果CNS组与non-CNS组患者在初始累及高危部位、头颅影像学结果、美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分和是否进行预防性中枢治疗方面比较,差异均具有统计学意义(均P<0.05),而在性别、年龄、乳酸脱氢酶(lactate dehydrogenase,LDH)水平、β2-微球蛋白(β2-microglobulin,β2-MG)、血清白蛋白(albumin,ALB)、LDH倍数、Lugano分期、CNS-国际预后指数(international prognostic index,IPI)评分、Ki-67指数、淋巴结数量和是否具有大包块方面比较,差异均无统计学意义(均P>0.05)。两组患者在颅内压力、蛋白定量、潘氏试验结果、是否能检测到淋巴瘤细胞和有核细胞计数比较,差异均具有统计学意义(均P<0.05),而在葡萄糖定量方面比较,差异无统计学意义(P>0.05)。分析其中44例弥漫大B细胞淋巴瘤患者显示,CNS组与non-CNS组仅能在有核细胞计数方面比较,差异具有统计学意义(P<0.05),而在颅内压力、蛋白定量、潘氏试验结果、是否能检测到淋巴瘤细胞和葡萄糖定量方面比较,差异均无统计学意义(均P>0.05)。结论脑脊液指标对淋巴瘤CNS浸润诊断有一定的参考意义,但需要更有效的诊断方法。

Objective To evaluate the diagnostic value of cerebrospinal fluid(CSF)indexes in central nervous system(CNS)infiltration of lymphoma by analyzing the clinical data of high-risk lymphoma patients.Methods The clinical data and CSF indexes of 92 patients with lymphoma who were in high risk and underwent lumbar puncture and sheath injection admitted to General Hospital of Northern The-ater Command from January 2015 to May 2021 were retrospectively analyzed.There were 16 patients with CNS infiltration(CNS group)and 76 patients with non-CNS infiltration(non-CNS group).Clinical features and CSF indexes,including intracranial pressure,protein quantification,Pandy's test,nucleated cell count,and lymphoma cells,were compared between the two groups.Results There were sig-nificant differences between the CNS group and non-CNS group in the initial involvement of high-risk sites,skull imaging results,Eastern Cooperative Oncology Group(ECOG)score and whether preventive central treatment was performed(all P<0.05).But the differences in sex,age,lactate dehydrogenase(LDH)level,β2-microglobin(β2-MG),serum albumin(ALB),LDH multiple,Lugano stage,CNS-international prognostic index(IPI)score,Ki-67 index,the number of lymph nodes,and the presence of large lump were not statistically significant(all P>0.05).There were statistically significant differences in intracranial pressure,protein quantification,Pandy's test results,detection of lymphoma cells and nucleated cell count between the two groups(all P<0.05),but there was no significant difference in glucose quantifi-cation(P>0.05).Analysis of 44 patients with diffuse large B cell lymphoma showed that the CNS group and the non-CNS group were only significantly different in nucleated cell count(P<0.05),and there were no significant differences in intracranial pressure,protein quantifi-cation,Pandy's test results,detection of lymphoma cells and glucose quantification(all P>0.05).Conclusions CSF indexes have a certain reference significance in the diagnosis of CNS infiltration of lymphoma,but more effective diagnostic methods are needed.