非霍奇金淋巴瘤患者骨髓浸润的诊断价值分析

Diagnosis and value analysis of bone marrow infiltration in patients with non-Hodgkin's lymphoma

目的探讨不同的检查方法在非霍奇金淋巴瘤(NHL)患者骨髓浸润诊断中的价值,并分析骨髓浸润与NHL其他临床特征、中期疗效的关系及对预后的影响。方法收集74例经病理确诊并在该院接受治疗NHL患者的病例资料,并进行随访调查,用常用的几种诊断试验评价指标评价不同检查方法对骨髓浸润的诊断价值;相关分析判断骨髓浸润与NHL其他临床特征的相关性;χ2检验分析骨髓浸润与NHL中期疗效的关系;K-M法生存分析判断骨髓浸润是否影响预后。结果 74例NHL患者中骨髓浸润22例,其中骨髓细胞学检出18例,骨髓病理学检出12例(共检查66例),PET/CT检出12例(共检查68例);骨髓浸润与B症状,IPI评分弱相关(P=0.012、0.007,r=0.290、0.311),与临床分期中度相关(P=0.000,r=0.731);骨髓浸润与中期疗效有关(χ~2=5.305,P=0.006);骨髓浸润患者的2年无进展生存率(PFS)和总生存率(OS)均低于无浸润患者,K-M生存分析发现无显著影响(Log Rank P=0.098、0.129)。结论骨髓细胞学、骨髓病理学及PET/CT三种方法对诊断骨髓浸润均有价值,三者联合诊断价值最大,推荐三种方法联合应用诊断骨髓浸润,有助于评估患者病情,及时制定适合的治疗方案,提高患者的生命质量并延长生存时间。

Objective To discuss the value of different methods in diagnosis of bone marrow infiltration(BMI)in the patients with non-Hodgkin′s lymphoma(NHL),and to analyze the correlation between BMI and other clinical features and mid-term efficacy,and to analyze the influence on prognosis of NHL.Methods The clinical data of 74 patients who were pathologically diagnosed with NHL and were treated in our hospital were collected.After follow-up survey,several common diagnostic test evaluation indicators were used to evaluate different examination methods to assess the diagnostic value of BMI.Correlation analysis was made to determine the correlation between BMI and other clinical features of NHL.Chi-square test was used to analyze the relationship between BMI and mid-term efficacy.The survival analysis of K-M method was used to determine the effect of BMI on the prognosis.Results 22 of the 74 cases had bone marrow infiltration,including 18 cases of bone marrow cytology,12 cases of bone marrow pathology(A total of 66 cases were examined),12 cases of PET/CT detection(A total of 68 cases were examined).BMI was weakly associated with B symptom,stages and IPI scores(P=0.012,0.007,r=0.290,0.311),and moderately associated with the clinical stages(P=0.000,r=0.731).BMI was related to the mid-term efficacy(χ2=5.305,P=0.006).2-year progression free survival and total survival rates in the patients with BMI were lower than those in the patients without infiltration,K-M survival analysis found no significant effect(Log Rank P=0.098,0.129).Conclusion Bone marrow cytology,bone marrow pathology and PET/CT are of great value to diagnose BMI in the patients with NHL.The combined diagnostic value of the three methods is the most valuable to increase the detection rate of BMI in NHL patients.