造血与淋巴组织肿瘤患者656份脑脊液细胞学结果分析

Analysis of 656 cerebrospinal fluid cytological results from patients with hematopoietic and lymphoid neoplasms

目的 回顾性分析该院造血与淋巴组织肿瘤患者656份脑脊液细胞学(CC)结果,结合患者脑脊液其他相关检查和临床特征,探讨其临床意义。方法 选取该院2020年4月至2021年9月血液内科收治的316例患者的656份CC标本,通过住院信息系统及LIS系统收集患者临床资料、脑脊液常规、生化及脑脊液流式细胞学(FCM)结果。结果 CC阳性标本53份,占8.1%,包含22例患者,其中急性淋巴细胞白血病的阳性率最高,占13.4%。CC阳性的患者在脑脊液外观上与CC阴性组没有差别,而蛋白定性阳性、有核细胞计数升高、葡萄糖降低、乳酸脱氢酶、乳酸、总蛋白及清蛋白升高有显著性差异。同时送检FCM共236份,FCM阳性21份(8.9%),其中CC阳性/FCM阳性13份(5.5%),CC阴性/FCM阳性8份(3.4%),FCM对于脑脊液异常肿瘤细胞检出率高于脑脊液细胞学,差异有统计学意义(P<0.001)。22例CC阳性患者中13例患者有中枢系统症状,17例患者在治疗后CC转阴,1例患者持续阳性,5例患者再次复发。结论 CC是造血与淋巴组织肿瘤中枢侵犯的金标准,结合脑脊液常规、生化、FCM有助于早期准确诊断,提早干预。

Objective To retrospectively analyze the results of 656 cerebrospinal fluid cytology(CC)samples from patients with hematopoietic and lymphoid tissue neoplasms in our hospital,combined with other related examinations and clinical characteristics of the patients′cerebrospinal fluid(CSF),to explore the clinical significance.Methods Six hundred and fifty-six CC specimens of 316 patients treated in the Department of Hematology of Tongji Hospital Affiliated to Tongji Medical College from April 2020 to September 2021 were selected.The clinical data,routine cerebrospinal fluid,biochemical and flow cytometry(FCM)results of patients were collected through the inpatient information system and LIS system.Results Fifty three CC positive samples,8.1%,contained 22 patients,of which acute lymphoblastic leukemia had the highest positive rate,13.4%.CC positive patients did not differ from the CC negative group in terms of CSF appearance,whereas protein qualitative positivity,elevated nucleated cell count,decreased glucose,increased LDH,increased lactate,and increased total protein and albumin were statistically significant.A total of 236 samples were also sent for FCM,21(8.9%)were positive by FCM,of which 13(5.5%)were CC positive/FCM positive and 8(3.4%)were CC negative/FCM positive,and FCM had a higher detection rate of abnormal tumor cells for CSF than for CSF cytology,the difference was statistically significant(P<0.001).Of the 22 CC positive patients,13 patients had central system symptoms,17 patients turned negative after treatment,1 patient continued to be positive,and 5 patients relapsed.Conclusion CC is the gold standard of hematopoiesis and lymphoid tissue tumor central invasion.Conclusion with cerebrospinal fluid routine,biochemistry and FCM,it is helpful for early accurate diagnosis and early intervention.