原发性胃淋巴瘤与原发性肠道淋巴瘤特征的比较

The comparative study of characteristics of primary gastric lymphoma and primary intestinal lymphoma

目的探讨原发性胃淋巴瘤（PGL）与原发性肠道淋巴瘤（PIL）在临床特征、病理特点、治疗及预后的异同点。方法回顾性分析48例PGL及15例PIL患者的临床特征、病理特点、治疗、幽门螺杆菌（Hp）检出情况及预后。结果PGL组和PIL组年龄、性别、腹痛、消化道出血、B症状、临床分期、死亡差异均无统计学意义（P值均〉0．05）；而病理分型、急腹症急诊手术差异均有统计学意义（P值均〈0．05）。PGL组黏膜相关淋巴组织（MALT）淋巴瘤Hp阳性12例（12／19），弥漫性大B细胞淋巴瘤（DLBCL）Hp阳性5例（5／20），两种病理类型中Hp检出率差异有统计学意义（P=0．025）。PIL组未检测Hp。COX多因素分析显示，Ⅲ、Ⅳ期是影响PGL预后的独立不良因素（P〈0．05），Ⅲ、Ⅳ期、B症状及T细胞型是影响PIL预后的独立不良因素（P〈0．05）。结论PGL以DLBCL和MALT淋巴瘤为主，PIL则以DLBCL为主。PIL比PGL好发T细胞淋巴瘤，PIL中MALT淋巴瘤少见。PGL及PIL均以Ⅲ、Ⅳ期为主，PIL常因肠套叠或穿孔需急诊手术。PGL预后与分期有关，PIL预后与分期、B症状及T细胞型有关。

Objective To explore the differences and similarities of clinical characteristics, pathological features, treatment and prognosis between primary gastric lymphoma（PGL）and primary intestinal lymphoma （PIL）. Methods The clinical characteristics, pathological features, therapeutic results, the detection of Helicobacter pylori （Hp） and prognosis of 48 PGL cases and 15 PIL cases were retrospectively analyzed. Results There was no statistical significance in age, gender, abdominal pain, gastrointestinal bleeding, B symptoms, clinical stage, mortality between PGL and PIL groups （P〉 0. 05）. However, there were significant differences in the pathological type, acute abdomen emergency surgery between these two groups （P〈0.05）. There was 12 HD positive cases in mucosalassociated lymphoid tissue （MALT） lymphoma of PGL group （12/19）, and 5 Hp positive cases in diffuse large B-cell lymphoma （DLBCL） （5/20）. There was significant difference in Hp detection rate of these two pathological types. Hp was not found in PIL group. The Cox multivariate analysis indicated that stageⅢ-Ⅳwas the independent adverse factors affecting PGL prognosis （P〈0.05）. Conclusions Mainly histological types are DLBCL and MALT lymphoma in PGL, and DLBCL in PIL. PIL predispose to T-cell lymphoma compared with PGL. MALT lymphoma is rare in PIL group. The mainly clinical stage is Ⅲ-Ⅳboth in PGL group and PIL group. Emergency surgery is often needed in PIL because of intussusception or perforation. The prognosis of PGL is correlated with the stage and the prognosis of PIL are correlated with the stage, B symptoms and T cell phenotype.