以高钙血症为首发表现的高龄老年弥漫大B细胞淋巴瘤4例临床分析

Diffuse large B cell lymphoma in elderly patients with hypercalcemia as initial manifestation: report of 4 cases and literature review

目的:分析弥漫大B细胞淋巴瘤(DLBCL)伴高钙血症患者的临床特点。方法:报道北京医院诊治的4例老年DLBCL伴高钙血症病例的临床表现、治疗经过和病情转归,并结合国内外报道的37例临床资料,比较高龄(≥75岁)和非高龄(<75岁)患者的临床特点。结果:男22例,女19例。年龄24~90岁,平均(65±16)岁。首发表现前3位包括意识改变(46.0%),局部疼痛(32.4%),恶心(18.9%)。高龄患者的血钙水平较非高龄患者低[(3.67±0.33)mmol/L vs(4.33±1.02)mmol/L,P<0.05]。高龄患者骨侵犯的发生率较非高龄患者明显降低(20%vs 75%,P<0.05)。高龄患者的1,25-羟基维生素D3升高发生率高于非高龄患者(78%vs 14%,P<0.05)。高龄患者的原发性甲状旁腺激素相关蛋白(PTHr P)升高发生率低于非高龄患者(40%vs 90%,P<0.05)。LDH在所有病例中均升高。高龄患者的化疗缓解率低于非高龄患者(36%vs 77%,P<0.05)。高龄患者生存时间低于非高龄患者[1(0.8,2.8)月vs 8(6.5,15)月,P<0.05]。结论:DLBCL合并高钙血症临床少见,高龄患者较非高龄患者预后更差。高钙血症临床表现缺乏特异性,以高钙血症为首发表现的病例要警惕淋巴瘤可能。

Objective： To analyze the clinical features of diffuse large B cell lymphoma complicated with hypercalcemia.Methods： We presented 4 diagnosed cases of hypercalcemia which antedated diffuse large B cell lymphoma in Beijing Hospital and reviewed 37 cases of diffuse large B cell lymphoma complicated with hypercalcemia previously reported in China and abroad. The differences of clinical features were compared between the elderly patients（ older than or equal to 75 years old）and non-elderly patients（ less than 75 years old）. Results： Of the 41 patients in total,there were 22 males and 19 females,with a mean age of（ 65 ± 16） years. The top three symptoms were altered consciousness（ 46%）,local pain（ 32. 4%） and nausea（ 18. 9%）. The blood calcium level was lower in elderly patients than in non-elderly patients [（ 3. 67 ± 0. 33）mmol/L vs（ 4. 33 ± 1. 02） mmol/L,P 〈 0. 05]. The incidence of bone metastasis was lower in elderly patients than in nonelderly patients（ 20% vs 75%,P 〈 0. 05）. The incidence of elevated 1,25-dihydroxy vitamin D was higher in elderly patients than in non-elderly patients（ 78% vs 14%,P 〈 0. 05）. The incidence of elevated PTHr P was lower in elderly patients than in non-elderly patients（ 40% vs 90%,P 〈 0. 05）. LDH was elevated in every recorded patient. The incidence of chemotherapy remission was lower in elderly patients than in non-elderly patients（ 36% vs 77%,P 〈 0. 05）. The survival time was shorter in elderly patients than in non-elderly patients [1（ 0. 8,2. 8） vs 8（ 6. 5,15）,P 〈 0. 05]. Conclusions： Diffuse large B cell lymphoma complicated with hypercalcemia is not common,and the prognosis is worse in the elderly patients. Hypercalcemia can perform nonspecific manifestation. When a patient presents with hypercalcemia,we should be vigilant against lymphoma.