非霍奇金淋巴瘤骨髓侵犯的临床及血液学分析

Clinical and Hematology Analysis of Bone Marrow Involuement in NHL

目的探讨NHL骨髓侵犯的临床特点以及与血液学之间的关系。方法分析95例NHL骨髓侵犯患者的临床资料,进行常规骨髓穿刺和血液学检查。结果发生骨髓侵犯病例中I期4例(4.2%),II期12例(12.6%),Ⅲ期36例(37.9%),Ⅳ期43例(47.4%);病理类型以小淋巴细胞性,弥漫型裂细胞性(改为:弥漫性大B细胞型淋巴瘤)和淋巴母细胞性淋巴瘤多见;纵隔淋巴结肿大、脾脏肿大和脾受侵患者易发生骨髓侵犯;骨髓侵犯患者外周血中贫血56例(58.9%),血小板减少42例(44.2%),白细胞减少27例(28.4%),白细胞增高49例(51.6%),以贫血多见;三项均异常30例(31.6%),至少一项不正常65例(68.4%),淋巴瘤细胞白血病患者外周血象异常发生率高于骨髓浸润患者,尤其是白细胞增高或三项均异常者更常见于白血病;66例(69.5%)外周血分类中发现异常细胞;骨髓侵犯化疗有效率65.2%,中位生存期11.5个月。结论NHL患者发生骨髓侵犯与临床分期、病理类型和受累部位相关,外周血象多有异常,应常规对初诊NHL患者进行骨髓检查,并要经常检测外周血象。

Objective To discuss the clinical features of NHL marrow invasion and its＂ relationship with hematology. Methods Analysis the clinical datum of 95 cases of NHL marrow invasion , make routine bone marrow aspiration and hematology test. Results In those patients with marrow invasion , 4 cases in Ⅰ phase（4. 2%） ,12 cases in Ⅱphase（12. 6%）,36 cases in Ⅲphase（37. 9%）and 43 cases in Ⅳ phase （47. 4%）;small lymphocytic.diffuse cleaved cell.lymphoblastic lymphoma are main pathologic types; patients with mediastinal lymphadenectasis, splenomegaly and spleen violations are prone to catch bone marrow involvement;56 cases of anemia in patients with bone marrow involuement（58. 9%）, 42 patients with thrombocytopenia （44. 2%）,27 cases with leukopenia （28. 4%）,49 cases of patients leukocyte increased （51.6%）, so,anemia is common;three were 30 cases with three items abnormal（31.6% ）and 65 cases with one item abnormal at least （68. 4%）, the incidence of abnormal peripheral blood in leukocythemia patients were higher than that in patients with bone marrow infiltration, Particularly the patients with increased leukocyte or three items abnormalities were more common in leukemia; Abnormal cells in peripheral blood were observed in 66 cases （69. 5%）; chemotherapy efficiency reached 65.2% in the patients with bone marrow involuement, the median survival time was 11.5 months. Conclusion Marrow invasion in NHL patients is related to clinical stage, pathological types and sites of involvement , bone marrow check should be done to the newly diagnosed NHL patients conventionally as well as the periphoral blood.