含利妥昔单抗化疗方案治疗弥漫大B细胞淋巴瘤致急性肺损伤患者26例临床分析

Clinical Analysis of Acute Lung Injury in 26 Cases of Diffuse Large B-Cell Lymphoma Treated with Rituximab Chemotherapy

目的:通过总结分析弥漫大B细胞淋巴瘤(DLBCL)患者应用含利妥昔单抗化疗方案后出现急性肺损伤的临床特点、治疗及预后,提高对该病的认识并指导临床治疗。方法:选择本院2013年1月至2018年9月收治的26例应用含利妥昔单抗化疗方案并出现急性肺损伤的DLBCL患者,对其临床特征、影像学表现、化疗疗程、治疗效果及预后进行分析。结果:患者主要临床症状为发热、咳嗽及胸闷;其中12例患者低氧血症,3例患者I型呼吸衰竭;胸部CT以双肺弥漫性磨玻璃影为主要表现,部分患者合并少量胸腔积液;发病时间主要分布在2-4个疗程,症状出现距方案中利妥昔单抗输注时间在8-49 d;25例患者治疗有效后日常生活无明显受限,1例患者治疗无效死亡。结论:弥漫大B细胞淋巴瘤应用含利妥昔单抗化疗方案后出现急性肺损伤早期无典型临床症状,早期发现及早期激素治疗对取得良好治疗效果至关重要。

Objective:To summarize and analyze the clinical characteristics,treatment and prognosis of acute lung injury in patients with diffuse large B-cell lymphoma(DLBCL)after chemotherapy with rituximab chemotherapy,so as to improve the understanding of the disease and guide the clinical treatment.Methods:Twenty-Six patients with DLBCL were treated with rituximab chemotherapy and developed to acute lung injury in Third Hospital of Peking University from January 2013 to September 2018 were selected.The clinical features,imaging findings,chemotherapy course,therapeutic effect and prognosis were analyzed.Results:The main clinical symptoms of patients were fever,cough and chest tightness,among which 12 patients showed hypoxia and 3 patients showed respiratory failure type I.The mainly manifested chest CT was diffusive glass grinding in both lungs,and some patients were complicated with a small amount of pleural effusion.The onset chemotherapy time was mainly distributed in 2 to 4 courses,the time between the onset of symptoms and the infusion of rituximab was 8 to 49 days.25 patients shows no obvious limitation in daily life after effective treatment,and 1 patient died of ineffective treatment.Conclusion:There are no typical clinical symptoms in the early stage of acute lung injury after rituximab chemotherapy in DLBCL.Early detection and early hormone therapy are very important to achieve good therapeutic effect.