胃黏膜相关淋巴组织淋巴瘤的临床特点及预后影响因素分析

Clinical characteristics and risk factors of prognosis in patients with gastric mucosa-associated lymphoid tissue lymphoma

目的探讨胃黏膜相关淋巴组织(MALT)淋巴瘤患者的临床特点及影响预后的危险因素。方法收集郑州大学第一附属医院2011年1月至2018年1月收治的70例胃MALT淋巴瘤患者的临床资料,并进行回顾性分析。结果70例胃MALT淋巴瘤患者中男38例,女32例,中位年龄54岁(19~82岁),幽门螺杆菌(Hp)阳性者47例(67.1%)。临床表现无特异性,表现为腹痛、腹胀、恶心、纳差、呕血、黑便等。内镜下表现以溃疡型为主,发病部位主要累及胃体、胃窦。AnnArbor分期ⅢE/IV期患者,更易出现不明原因的体温大于38℃、体质量减轻、盗汗(B症状)和贫血;IPI评分、血清乳酸脱氢酶、β2微球蛋白升高,与ⅢE/Ⅳ期患者比较差异均有统计学意义(P均<0.05)。预后分析结果显示:年龄>60岁、B症状、β2微球蛋白、乳酸脱氢酶、IPI评分>2分均与患者无进展生存(PFS)及总生存时间(OS)有相关性(P均<0.05)。IPI评分>2分、Hp感染是影响PFS的独立预后不良因素。结论胃MALT淋巴瘤是一种罕见的惰性肿瘤,经初始治疗后,临床缓解率高,但仍需进行长期密切随访。

Objective To analyze the clinical features and risk factors of prognosis in patients with gastric mucosa-associated lymphoid tissue(MALT)lymphoma.Methods The clinical data of 70 patients with gastric MALT lymphoma admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2018 were collected and retrospectively analyzed.Results There were 38 males and 32 females with a median age of 54 years(19-82 years)in the 70 cases of MALT lymphoma.Helicobacter pylori(Hp)infection was detected in 47 patients(67.1%).Patients with gastric MALT had no specificity in clinical manifestations,and the symptoms were abdominal pain,abdominal distension,nausea,poor appetite,hematemesis,melena.Endoscopic manifestations were mainly ulcerative,and the main site of the disease involved gastric body and autrum.Ann Arbor stageⅢE/IV patients were more prone to occur B symptoms(unexplained body temperature>38℃,body mass reduction,night sweats)and anemia;IPI score,serum lactate dehydrogenase andβ2-microglobulin significantly increased,and the differences were significant(P<0.05).The prognostic analysis showed that age>60 years,B symptoms,β2-microglobulin,lactate dehydrogenase,and IPI score>2 were all correlated with PFS and OS(P all<0.05).IPI score>2 and Hp infection were independent prognostic factors affecting progress-free survival.Conclusions Gastric MALT lymphoma is a rare and indolent tumor.After initial treatment,the clinical remission rate is high,but long-term close follow-up is still needed.