论文部分内容阅读
目的探讨以多浆膜腔积液、Warburg效应为临床表现的弥漫性大B细胞淋巴瘤(DLBCL)的临床诊断与治疗。方法回顾性分析以多浆膜腔积液、Warburg效应为主要临床表现患者1例,男,51岁,因腹痛、腹胀1个月,右侧胸痛7 d入院,行CT、PET-CT、内科胸腔镜检查。通过系统检索中国知网和Pubmed等中英文数据库,纳入2010至2016年有关大B细胞淋巴瘤、large B-cell lymphoma、低血糖、高乳酸、肿瘤、hypoglycemia、lactic acidosis、tumor等关键词的文献,并进行文献复习。结果 CT检查示胸腔、腹腔积液,超声心动图示少量心包积液;PET-CT示双侧胸膜、腹膜葡聚糖高摄取率;入院后多次血糖检测低于正常,最低至1.17 mmol/L,血乳酸异常升高;胸水乳酸脱氢酶5 158 U/L,CA-125 3 251 U/m L;胸水细胞学检查见原幼淋巴样细胞;胸腔镜活检病理确诊DLBCL。随之给予化疗3周期,症状缓解。检索文献605篇,共报道3 981例DLBCL,累及1处及以上浆膜腔者108例(2.71%),多浆膜腔累及者30例(0.75%);低血糖、高乳酸血症个案报道15例,均为国外文献报道,15例中非霍奇金淋巴瘤13例,其中DLBCL 4例,Burkitt淋巴瘤3例,T细胞淋巴瘤2例,另有4例未提及淋巴瘤具体分型。结论以多浆膜腔积液、Warburg效应为临床表现的DLBCL较少见,胸腔镜检查对多浆膜腔积液疾病的诊断及其鉴别诊断颇具优势。
Objective To investigate the clinical diagnosis and treatment of diffuse large B cell lymphoma (DLBCL) with pleural effusion and Warburg effect. Methods A retrospective analysis was performed on one patient with multiple serous effusion and Warburg effect as the main clinical manifestations. The age was 51 years. The patients were admitted to hospital for abdominal pain, bloating for 1 month and right chest pain for 7 days. CT, PET-CT, Thoracoscopy. By systematically searching Chinese and English databases such as CNKI and Pubmed, the literature about key words such as large B-cell lymphoma, hypoglycemia, high lactic acid, tumor, hypoglycemia, lactic acidosis and tumor from 2010 to 2016 was included , And review the literature. Results CT examination showed thorax, ascites and echocardiography showed a small amount of pericardial effusion; PET-CT showed a high rate of bilateral pleura and peritoneal dextran; the blood glucose level was lower than normal after admission, the lowest was 1.17 mmol / L, blood lactic acid was abnormally elevated; lactate dehydrogenase in the pleural effusion 5 158 U / L, CA-125 3 251 U / m L; pleural fluid cytology see the original immature lymphoid cells; thoracoscopic biopsy confirmed DLBCL. Followed by chemotherapy for 3 cycles, symptoms relieved. A total of 605 articles were retrieved, of whom 3 981 DLBCL were reported, 108 cases (2.71%) were involved in one or more serosal cavities and 30 cases (0.75%) were involved in multiple serosal cavities. Cases of hypoglycemia and hyperlactia were reported 15 cases were reported in foreign literature, 15 cases of Hodgkin’s lymphoma in 13 cases, including DLBCL in 4 cases, Burkitt lymphoma in 3 cases, T-cell lymphoma in 2 cases, and the other 4 cases did not refer to specific lymphoma type. Conclusions Multilocular effusion and Warburg effect are rare clinical manifestations of DLBCL. Video-assisted thoracoscopic diagnosis of multiple serous cavitation disease and its differential diagnosis have advantages.