肺淋巴瘤临床特征分析

Analysis of clinical features in pulmonary lymphoma

目的探讨肺淋巴瘤的临床特征,以提高对该病的认识。方法对2014年10月至2017年3月吉林省肿瘤医院淋巴血液科收治的253例淋巴瘤患者的临床资料进行回顾性分析。其中肺淋巴瘤患者30例(肺淋巴瘤组)和非肺淋巴瘤患者223例(对照组)。分别采用速率法和乳胶比浊法检测乳酸脱氢酶(LDH)和β2微球蛋白(β2-MG)。采用流式细胞术检测外周血CD4+和CD8+T淋巴细胞程序性死亡受体1 ( PD-1 )、程序性死亡受体配体1 ( PD-L1 )及细胞毒T淋巴细胞抗原4( CTLA-4 )的表达。两组计数资料比较采用X^2检验.计量资料比较采用t检验。结果肺淋巴瘤组患者均为继发性病变。肺淋巴瘤组与对照组相比,吸烟患者比例高[43.3 %( 13/30)比24.2 %( 54 / 223 ),X^2 = 4.964,P=0.026 ],Ⅲ~Ⅳ期患者比例高[93.3 %( 28/30 )比 57.0 %( 127/223 ), X^2 = 14.750, P< 0.001 ],国际预后指数(IPI)评分偏高患者比例高(X^2=21.888,P< 0.001 )。肺淋巴瘤组β2-MG表达升高患者比例高,与对照组比较,差异无统计学意义[66.7 %( 20/30 )比50.2 %( 112/223 ), X^2 = 6.682,P = 0.091];肺淋巴瘤组LDH升高患者比例较对照组高,差异有统计学意义[63.3 %( 19/30 )比41.5 %( 86 / 223 ),X^2=6.682,P= 0.010 ].肺淋巴瘤组患者病理类型中以弥漫性大B细胞淋巴瘤(DLBCL )最常见(15例),其次为霍奇金淋巴瘤(HL )( 7例);影像学上单发肿块/结节型占36.7 %( 11 / 30 ),多发肿块/结节型占30.0%(9/30),双肺浸润占63.3 %( 19/30),胸腔积液占36.7 %( 11 / 30 ) o两组外周血PD-1、PD-L1和CTLA-4等免疫检查点蛋白表达阳性率差异均无统计学意义(均P>0.05 ).结论肺DLBCL应考虑为继发性而非原发性病变,肺淋巴瘤患者吸烟率高,与其他结外淋巴瘤相似.IPI评分高、分期晚且LDH升高。

Objective To investigate the clinical features of pulmonary lymphoma and to get a better understanding of this disease. Methods Clinical data of 253 lymphoma patients in the Department of Lymphoma and Hematology in Jilin Cancer Hospital from October 2014 to March 2017 were retrospectively analyzed. The patients were divided into 30 cases of pulmonary lymphoma (lung lymphoma group) and 223 cases of non-pulmonary lymphoma (the control group). Rate assay and latex turbidimetry was used to detect lactic dehydrogenase (LDH) and β2 macroglobulin (β2-MG) respectively. The expressions of programmed death 1 (PD-1), programmed death ligand 1 (PD-L1) and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) in peripheral blood CD4 + CD8 + T lymphocytes were detected by using flow cytometry. The count and measurement data of both groups were compared by using X^2 test and t test respectively. Results The patients in pulmonary lymphoma group showed secondary lesions. The proportion of smoking people in pulmonary lymphoma group was higher than that in the control group [43.3 %(13/30) vs. 24.2 %(54/223), X^2= 4.964, P = 0.026]. The proportion of the patients in DI-IV stage in pulmonary lymphoma group was higher than that in the control group [93.3 %(28/30) vs. 57.0 %(127/223), X^2= 14.750, P < 0.001)]. The proportion of the patients with higher international prognostic index (IPI) score in pulmonary lymphoma group was higher than that in the control group (X^2 = 21.888, P < 0.001). The proportion of the patients with increased expression of β2-MG in pulmonary lymphoma group was higher compared with the control group [66.7 %(20/30) vs. 50.2 %(112/223), X^2=6.682, P = 0.091]. The proportion of the patients with the increased LDH was higher compared with the control group [63.3 %(19/30) vs. 41.5 %(86/223)], and the difference was statistically significant (X^2 = 6.682, P = 0.010). Diffuse large B-cell lymphoma (DLBCL) was the common pathological type in pulmonary lymphoma group (15 cases), followed by Hodgkin lymphoma (7 cases);imaging showed single mass or nodular type, multiple masses or nodular type, bilateral pulmonary infiltration, pleural effusion were 36.7 %(11/30), 30.0 %(9/30), 63.3 %(19/30) and 36.7 %(11/30), respectively. There were no statistical differences in the protein expression of immune check points such as PD-1, PD-L1 and CTLA-4 in both groups (all P > 0.05). Conclusions Pulmonary DLBCL should be considered a secondary disease, but not a primary lesion. Smoking history is a risk factor for lymphoma patients with pulmonary involvement. Pulmonary lymphoma is similar to other extra-nodal lymphoma with high IPI scores, advanced stage and elevated LDH.