以发热为主要表现的非霍奇金淋巴瘤(附50例临床分析)

The Diagnosis of non-Hodgkin's lymphoma(NHL) with fever

目的 探讨以发热为主要表现的非霍奇金淋巴瘤(NHL)的临床表现和诊断方法。方法 回顾分析50例以发热为主要表现的NHL患者的临床资料。结果 ①NHL的热型多样;②其他临床表现更为复杂,94％的患者有两个以上系统的异常表现;③诊断NHL的方法多样,影像学引导下穿刺活检确诊NHL的几率小,而通过骨髓涂片或骨髓活检来确诊NHL的几率较大,84％的病例为ⅣB期NHL;④三系减少、多浆膜腔积液和肝功能恶化提示预后较差;⑤发热为主要表现的NHL患者的死亡率明显高于不发热组(P<0.01)。结论以发热为主要表现的NHL临床症状复杂,热型不规则,确诊依靠病理,尤其在影像学引导下对病灶行细针穿刺找到淋巴瘤细胞意义更大。个别高度怀疑伴肝脾或腹腔淋巴结肿大者行剖腹探查(脾切除术+肝、淋巴结活检)可提高早期确诊率。

Objective To discover the clues of diagnosis of NHL by analysing the presentation of 50 NHL cases with fever. Methods Retrospectively analysis the clinical presentations and diagnosis of 50 NHL with fever from 151 cases that were diagnosed with lymphoma in Peking Union Hospital between September 1999 and December 2001. Results ①The pattern of fever varied widely. ②Other clinical characteristics are complicated in 94% patients who had abnormalities in more than two systems. ③Biopsy can be taken from different spots, the positive diagnostic rate of image-guided needle biopsy is lower than bone marrow aspiration and bone marrow core biopsy in NHL patients. ④Cytopenia,multiple-sero-cavities effusion and deterioration of liver function suggests poor prognosis. ⑤The NHL patients with fever had higher mo-tality rate than those without fever(P<0.01).Conclusions ①The fever of NHL can be caused by tumor cells, infection and damage of central nervous system. ②Though the positive diagnostic rate of image-guided needle biopsy is low in our hospital, the data over the world advocates this procedure. ③Though the long term effects of splenectomy on survival rate is unknown, it is widely accepted by doctors on the purpose of diagnosis and treatment of NHL, especially since laparoscopic splenectomy is used.