Usenko Ganna, Gashynova Kateryna
City Hematology Center, Public Non-profit Enterprise "City Clinical Hospital #4" of Dnipro City Council, Dnipro, UKR.
Department of Occupational Diseases, Clinical Immunology and Clinical Pharmacology, Dnipro State Medical University, Dnipro, UKR.
Cureus. 2022 Mar 7;14(3):e22935. doi: 10.7759/cureus.22935. eCollection 2022 Mar.
Introduction The presence of concomitant respiratory pathology complicates the process of treatment and recovery of patients with chronic lymphoproliferative diseases (CLDs). Therefore, the diagnosis of lung injury is an important step in the management of such patients. Objectives The aim of this study was to determine the prevalence, nature, extent, and location of changes diagnosed by high-resolution chest computed tomography (CT) in patients with CLDs at the initial examination. Methods Medical records of inpatients who were hospitalized in 2018-2019 to the City Hematology Center of the Public Non-Profit Enterprise "City Clinical Hospital #4" of Dnipro City Council with a confirmed clinical diagnosis of CLDs were included in the retrospective study. The results of initial high-resolution chest CT were studied and analyzed. Results Out of 1,004 hospitalized patients with confirmed CLDs, 119 patients were primarily diagnosed. Among them, 81 patients underwent chest CT examination (68.1%) before the beginning of specific therapy. The average age was 65 (56;68) years, 46 (56.8%) were men. 23 (28.4%) patients were diagnosed with chronic lymphocytic leukemia, 28 (34.6%) patients with multiple myeloma, 24 (29.6%) patients with lymphoma, and six patients (7.4%) had other CLDs. It was found that both central and peripheral lymphadenopathy had about a third of the studied cohort of patients (33.3 and 29.6%, respectively), and these symptoms dominated in patients with chronic lymphocytic leukemia (43.5 and 50%, respectively), lymphoma (50 and 52.2%, respectively), and other CLDs (45.8 and 16.7%, respectively), in contrast to patients with multiple myeloma (7.1 and 0%, respectively). Lesions of the lung parenchyma were found in 45.7% of the studied cohort and were met more often in patients with multiple myeloma (67.9%). However, when comparing the prevalence of their categories, no statistically significant differences were found. Predictable bone-destructive changes were statistically significantly more common in patients with multiple myeloma than in other groups of patients with CLDs (=0.0003). Conclusions Signs of pulmonary diseases during initial chest CT were found almost in half of the patients with CLDs. It potentially may affect the frequency of treatment complications in such patients. Lymphadenopathy was the most common finding on chest CT, especially in patients with chronic lymphocytic leukemia and lymphoma. And enlarged intrathoracic lymph nodes possibly could lead to pulmonary functions disorders. Among the types of lung parenchyma lesions, pneumofibrosis and foci of consolidation in the lower lung lobes were the most often diagnosed. Chest CT is informative at the stage of the initial examination of patients with CLDs not only for clinical diagnosis but also for the diagnosis of respiratory comorbidities and prediction of the disease outcome and treatment complications.
引言 合并存在的呼吸系统病变会使慢性淋巴细胞增殖性疾病（CLD）患者的治疗和康复过程变得复杂。因此，肺部损伤的诊断是此类患者管理中的重要一步。
目的 本研究的目的是确定初诊时CLD患者经高分辨率胸部计算机断层扫描（CT）诊断出的病变的患病率、性质、范围和位置。
方法 对2018 - 2019年在第聂伯市议会公共非营利企业“第4市立临床医院”市血液中心住院且临床确诊为CLD的患者的病历进行回顾性研究。研究并分析了初次高分辨率胸部CT的结果。
结果 在1004例确诊为CLD的住院患者中，119例为初诊。其中，81例患者（68.1%）在开始特异性治疗前接受了胸部CT检查。平均年龄为65（56；68）岁，46例（56.8%）为男性。23例（28.4%）患者诊断为慢性淋巴细胞白血病，28例（34.6%）患者诊断为多发性骨髓瘤，24例（29.6%）患者诊断为淋巴瘤，6例（7.4%）患者患有其他CLD。发现中央和外周淋巴结病在约三分之一的研究队列患者中出现（分别为33.3%和29.6%），并且这些症状在慢性淋巴细胞白血病患者中占主导（分别为43.5%和50%）、淋巴瘤患者中（分别为50%和52.2%）以及其他CLD患者中（分别为45.8%和16.7%），与多发性骨髓瘤患者相反（分别为7.1%和0%）。肺实质病变在45.7%的研究队列中被发现，并且在多发性骨髓瘤患者中更常见（67.9%）。然而，比较其类别患病率时，未发现统计学上的显著差异。可预测的骨破坏改变在多发性骨髓瘤患者中比在其他CLD患者组中在统计学上显著更常见（P = 0.0003）。
结论 在几乎一半的CLD患者初诊胸部CT时发现了肺部疾病迹象。这可能会影响此类患者治疗并发症的发生率。淋巴结病是胸部CT上最常见的发现，尤其是在慢性淋巴细胞白血病和淋巴瘤患者中。并且胸腔内肿大的淋巴结可能导致肺功能障碍。在肺实质病变类型中，肺纤维化和下肺叶实变灶是最常被诊断出的。胸部CT在CLD患者初诊阶段不仅对临床诊断有帮助，而且对呼吸合并症的诊断以及疾病结局和治疗并发症的预测也有帮助。
