文章摘要
刘高双,王宇晴,李培培,于莲珍.原发于胃肠道的黏膜相关淋巴组织淋巴瘤及弥漫性大B细胞淋巴瘤临床表现及内镜特征的比较[J].南京医科大学学报,2018,(1):67~71
原发于胃肠道的黏膜相关淋巴组织淋巴瘤及弥漫性大B细胞淋巴瘤临床表现及内镜特征的比较
A comparative study of clinical and endoscopic features of 119 cases of patients with MALT lymphoma and diffuse large B cell lymphoma in the gastrointestinal tract
投稿时间:2017-01-18  
DOI:10.7655/NYDXBNS20180115
中文关键词: 黏膜相关淋巴组织淋巴瘤  弥漫性大B细胞淋巴瘤  临床特点  诊断  内镜特征
英文关键词: mucosa⁃associated lymphoid tissue lymphoma  diffuse large B⁃cell lymphoma  clinical characteristics  diagnosis  endoscopic characteristics
基金项目:江苏省六大人才高峰(2012)
作者单位
刘高双 南京医科大学第一附属医院消化内科江苏 南京 210029 
王宇晴 南京医科大学第一附属医院消化内科江苏 南京 210029 
李培培 南京医科大学第一附属医院消化内科江苏 南京 210029 
于莲珍 南京医科大学第一附属医院消化内科江苏 南京 210029 
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中文摘要:
      目的:回顾性分析原发于胃肠道的黏膜相关淋巴组织淋巴瘤(mucosa?associated lymphoid tissue lymphoma,MALT淋巴瘤)和弥漫性大B细胞淋巴瘤(diffuse large B?cell lymphoma,DLBCL)两种类型淋巴瘤的临床表现、内镜特征,探讨其确诊方式的差异。方法:对2009年1月—2016年7月经病理学证实的119例原发于胃肠道的MALT淋巴瘤和DLBCL患者资料进行回顾性分析。结果:119例患者中MALT淋巴瘤男女比为1.73∶1,DLBCL男女比≈1。两组发病中位年龄均为55岁。MALT淋巴瘤与DLBCL均主要累及胃部,前者以胃体多见,后者以胃窦多见。临床表现均以腹部不适为主,其次为体重减轻、消化道出血等。内镜下确诊率为74.8%。MALT淋巴瘤患者仅通过内镜下黏膜剥离切除术/内镜下黏膜整片切除术(EMR/ESD)确诊病例明显多于DLBCL患者(P=0.006),其余方式均无统计学差异(P > 0.05)。内镜下常见表现:溃疡型、黏膜隆起型、浅表型、肿块或息肉样型,两组均以溃疡型最多见。MALT淋巴瘤患者中Ⅰ~Ⅱ期占73.2%,DLBCL患者中Ⅰ~Ⅱ期占42.3%,两组间差异具有统计学意义(P=0.001)。DLBCL患者中乳酸脱氢酶(LDH)高水平者明显多于MALT淋巴瘤(P=0.002)。幽门螺杆菌总体检测率为63.0%,MALT淋巴瘤阳性率为53.1%,DLBCL阳性率为46.5%。结论:MALT淋巴瘤和DLBCL临床表现多样,内镜确诊率高,内镜确诊方式为组织活检、大块组织EMR或ESD,内镜下病变形态以溃疡型最多见。MALT淋巴瘤患者通过EMR/ESD确诊病例明显多于DLBCL患者,且临床分期MALT淋巴瘤多为早期,DLBCL多为晚期。而DLBCL患者中高水平LDH的多于MALT淋巴瘤。
英文摘要:
      Objective:Through the difference of clinical and endoscopic feature,to explore the diagnosis between the patients with MALT lymphoma and diffuse large B cell lymphoma in the gastrointestinal tract. Methods:A total of 119 patients with MALT lymphoma and diffuse large B cell lymphoma in the gastrointestinal tract proven by pathology from January 2009 and to July 2016,were retrospectively analyzed. Results:Of the 119 cases,The male?to?female ratio of MALT lymphoma and DLBCL were respectively 1.73:1,≈1 and the median age was 55 years. However,MALT lymphoma and DLBCL were both mainly involved in the stomach,but the most frequent site of MALT lymphoma was body of the stomach,as to DLBCL,antrum of the stomach was the most frequent site. The most common symptom of MALT lymphoma and DLBCL was both abdominal discomfort,followed by weight loss,gastrointestinal bleeding and so on. The diagnosis rate of gastrointestinal endoscopy was 74.8%. Patients with MALT lymphoma diagnosed by EMR/ESD were more than patients with DLBCL(P=0.006),and the two groups diagnosed by the way of biopsy and surgical had no statistical difference(P > 0.05). Endoscopic performance mainly presented as ulcerative type,mucosal uplift type,superficial type,tumer?like and polypoid type. The most common type of the two groups was both ulcerative type. MALT lymphoma was 73.2% in stageⅠ ~ Ⅱand DLBCL was 42.3% in stageⅠ ~ Ⅱ. There was statistically significant difference between the two groups(P=0.001).The patients with higher level of LDH were significantly more common in DLBCL than in MALT lymphoma(P=0.002). In addition,the positive rate of MALT lymphoma group and DLBCL group respectively were 53.1%,46.5%. Conclusion:Patients with MALT lymphoma and DLBCL were varied in clinical manifestations. The rate of endoscopic diagnosis was high and the ways of endoscopic diagnosis included biopsy,EMR or ESD of large organizations. The most common endoscopic lesion was ulcerative type. Patients with MALT lymphoma diagnosed by EMR/ESD were more than patients with DLBCL,and clinical staging of MALT lymphoma are early and DLBCL are advanced. The patients of high levels of LDH in DLBCL are more than MALT lymphoma.
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