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14例淋巴瘤相关噬血细胞综合征患者的临床分析

[Clinical analysis of 14 patients with lymphoma associated hemophagocytic syndrome].

作者信息

Wang Jing-Shi, Wang Zhao, Wu Lin, Tian Li-Ping, Chen Xi

机构信息

Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

出版信息

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2009 Oct;17(5):1352-5.

PMID:19840482
Abstract

The study was aimed to investigate the clinical characteristics, diagnosis and therapy of patients with lymphoma associated hemophagocytic syndrome (LAHS) so as to provide the clinical basis for improving its recognition and giving effective therapy. The clinical data of 14 patients with LAHS in Beijing Friendship Hospital, Capital Medical University during the period from June 2005 to May 2008 were collected, the informations including primary diseases, clinical manifestations, laboratory findings, therapy and outcome were analyzed retrospectively, the coincidence of each diagnostic index was compared before and after diagnosis. All 14 patients were given therapeutic regimens containing fludarabine, methylprednisolone and gammaglobulin (FDIg) after final diagnosis. The results indicated that 100% patients had abnormal changes on NK cell activity and sCD25 level in serum, but hemophagocytosis in less than 40% patients at early stage was found in bone marrow. Even after confirmed diagnosis of the disease, the percentage of patients with hemophagocytosis was not up to 50%. 9 out of the 14 patients had a good prognosis after treatment, and the other 5 patients died. It is concluded that the detection of NK cell activity and sCD25 level in serum may be valuable for the early diagnosis of LAHS, the hemophagocytosis is not necessary for the diagnosis of LAHS. Fludarabine combined with methylprednisolone and gamma globulin may provide a new strategy for LAHS therapy.

摘要

本研究旨在探讨淋巴瘤相关噬血细胞综合征(LAHS)患者的临床特征、诊断及治疗方法,为提高其识别率和实施有效治疗提供临床依据。收集首都医科大学附属北京友谊医院2005年6月至2008年5月期间14例LAHS患者的临床资料,对其原发疾病、临床表现、实验室检查结果、治疗及转归等信息进行回顾性分析,比较诊断前后各项诊断指标的符合情况。最终确诊后,14例患者均接受含氟达拉滨、甲泼尼龙及丙种球蛋白(FDIg)的治疗方案。结果显示,100%的患者NK细胞活性及血清sCD25水平有异常改变,但早期骨髓中噬血细胞现象的患者不足40%。即使在确诊疾病后,噬血细胞患者的比例仍未达到50%。14例患者中9例治疗后预后良好,另外5例死亡。结论:检测血清NK细胞活性及sCD25水平可能对LAHS的早期诊断有价值,LAHS的诊断不一定需要噬血细胞现象。氟达拉滨联合甲泼尼龙及丙种球蛋白可能为LAHS的治疗提供新策略。

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