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目的探讨脑脊液细胞学、免疫细胞化学和流式细胞分析在脑膜淋巴瘤诊断中的灵敏性和特异性。方法13例诊断为脑膜淋巴瘤的患者,其中原发性中枢神经系统淋巴瘤5例,均为非霍奇金淋巴瘤B细胞型(NHL-B);继发性8例,包括NHL-B 6例,非霍奇金淋巴瘤T细胞型(NHL-T)1例,m antle型1例。神经系统表现为头痛、视乳头水肿、脑脊膜刺激征、脊髓腰骶神经根受累和多脑神经麻痹等。腰穿脑脊液压力升高,细胞计数、蛋白均升高,糖减低。所有患者均采用沉淀池法,免疫细胞化学单克隆抗体CD19、CD20、CD79a、CD34和免疫球蛋白轻链等;其中3例脑脊液进行淋巴细胞亚群流式细胞分析。以4例病毒性脑炎和5例炎性脱髓鞘病患者的脑脊液为对照。结果脑脊液细胞学发现每例患者均有淋巴瘤细胞或异型淋巴细胞。免疫细胞化学发现5例患者多数细胞B细胞标记物阳性;例6多数细胞CD34阳性;例8 CD20阳性细胞比例升高;例7 CD19、CD20阴性。除例8外,其余脑脊液中细胞呈CD4和CD8阴性或极少数阳性。对照组CD4阳性细胞为主,伴有少量CD8阳性细胞,CD19和CD20阴性或极少数阳性。脑脊液流式细胞分析发现例9和例11的B淋巴细胞占85.9%~97.4%,提示异常的B细胞克隆。对照组以CD4、CD8阳性细胞为主,CD19阳性细胞低于4.0%。结论脑脊液细胞学和免疫细胞化学是诊断脑膜淋巴瘤的重要方法,脑脊液淋巴细胞亚群的流式分析能够对诊断脑膜淋巴瘤有所帮助。
Objective To investigate the sensitivity and specificity of cerebrospinal fluid cytology, immunocytochemistry and flow cytometry in the diagnosis of meninges lymphoma. Methods Thirteen patients were diagnosed as meningioma, including 5 patients with primary central nervous system lymphoma, all of which were non-Hodgkin’s lymphoma B cell type (NHL-B). Secondary 8 patients included NHL-B 6 cases, non-Hodgkin’s lymphoma T cell type (NHL-T) in 1 case, m antle type in 1 case. Neurological manifestations of headache, papilledema, meningeal irritation, spinal cord lumbosacral nerve root involvement and multiple nerve paralysis. Lumbar wear cerebrospinal fluid pressure, cell count, protein were increased, reduced sugar. All patients were treated with sedimentation tank method, immunocytochemistry monoclonal antibodies CD19, CD20, CD79a, CD34 and immunoglobulin light chain; 3 cases of cerebrospinal fluid flow cytometry analysis of lymphocyte subsets. Cerebrospinal fluid of 4 patients with viral encephalitis and 5 patients with inflammatory demyelinating disease was used as control. Results Cerebrospinal fluid cytology found that every patient had lymphoma cells or atypical lymphocytes. Immunocytochemistry found that most of the 5 patients had positive B cell markers; 6 most of the cells were positive for CD34; 8 had a higher proportion of CD20 positive cells; 7 were negative for CD19 and CD20. Except for Example 8, the remaining CSF positive cells were negative for CD4 and CD8, or very few. The control group CD4-positive cells, with a small amount of CD8-positive cells, CD19 and CD20 negative or very few positive. CSF FACS analysis found that B and B lymphocytes in Examples 9 and 11 account for 85.9% to 97.4%, suggesting abnormal B cell clones. In the control group, CD4 and CD8 positive cells were predominant while CD19 positive cells were below 4.0%. Conclusions Cerebrospinal fluid cytology and immunocytochemistry are important methods for the diagnosis of meningioma. Flow cytometry analysis of lymphocyte subsets in cerebrospinal fluid can be helpful in the diagnosis of meningioma.