弥漫大B细胞淋巴瘤中枢神经系统浸润的临床研究

Clinical research on central nerve system infiltration in patients with diffuse large B-cell lymphoma

目的研究弥漫大B细胞淋巴瘤（DLBCL）患者中枢神经系统（CNS）浸润的发生率、临床表现、危险因素和预后。方法回顾性分析2005年1月至2012年1月确诊DLBCL之后出现中枢神经系统浸润患者的临床资料。结果入组DLBCL患者168例，发生CNS浸润11例（6．5％）。11例中6例表现为软脑膜浸润，3例表现为脑实质多发浸润，2例同时有两者的浸润。美国东部肿瘤协作组（ECOG）评分≥2、乳酸脱氢酶（LDH）水平〉正常上限2倍和多发结外病变是影响DLBCLCNS浸润的相关因素（χ2值分别为11．6、4．61、3．92，均P〈0．005）。出现CNS浸润后患者平均生存期仅4．5个月。结论DLBCL患者发生CNS浸润并不罕见，其表现与急性淋巴细胞白血病不同。发生CNS浸润的DLBCL患者预后差。

Objective To evaluate the morbidity, clinical manifestation, risk factors and prognosis of diffuse large B-cell lymphoma（DLBCL） patients with central nerve system（CNS） infiltration. Methods Clinical data of DLBCL patients with CNS infiltration between Jan 2005 and Jan 2012 were reviewed. Results Among 168 DLBCL patients, 11 patients （6.5 %） had CNS infiltration. ECOG scores ≥ 2, elevated lactate dehydrogenase （LDH） 〉 2 times of normal range and the involvement of ≥ 2 extranodal sites were clinical risk factors associated with CNS infiltration（ χ2 = 11.6, 4.61, 3.92, all P 〈 0.005）. Median survival time after CNS infiltration was 4.5 months. Conclusion DLBCL patients with CNS infiltration are not rare, the patients demonstrate significantly bad prognosis.