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目的探讨以呼吸道症状为首发表现的淋巴瘤患者的临床特点。方法回顾性分析2014年1月至2015年12月因呼吸道症状首诊于呼吸内科的9例淋巴瘤患者的临床资料,结合文献复习并讨论。结果 9例患者中,男7例,女2例,平均年龄48.2岁,中位病程约20 d。所有患者均行病理检查明确诊断,其中颈部淋巴结活检2例,CT引导下经皮肺穿刺活检2例,气管镜黏膜活检2例,气管镜纵隔淋巴结穿刺活检1例,胸腔镜肺活检1例,腹水细胞块检查1例。患者症状主要为咳嗽(7/9)、咳痰(3/9)、发热(3/9)、喘息(2/9)。胸部CT表现为肺部肿块(3/9,1例多发)、纵隔淋巴结肿大(6/9)、肺门淋巴结肿大(3/9)、肺实变(3/9)、胸腔积液(6/9,3例双侧)、胸膜增厚(2/9)、肺不张(2/9)、斑片状影(7/9)、心包积液(1/9)。实验室检查发现7例患者癌抗原125(CA125)升高,4例乳酸脱氢酶(LDH)升高。住院期间死亡1例,自动出院1例。随访过程中死亡1例,5例患者目前仍随访中。结论淋巴瘤患者的呼吸道症状不典型,胸部影像学表现各异,CA125、LDH等指标对判断病情及评价预后可起到一定作用。
Objective To investigate the clinical features of lymphoma patients with respiratory symptoms as the first manifestation. Methods The clinical data of 9 patients with lymphoma, who were first diagnosed as Respiratory Symptoms from January 2014 to December 2015 in Respiratory Medicine, were retrospectively reviewed and reviewed. Results Among the 9 patients, there were 7 males and 2 females, with an average age of 48.2 years and a median duration of 20 days. All patients underwent pathological examination with definite diagnosis. Among them, 2 were cervical lymph node biopsy, 2 were CT-guided percutaneous lung biopsy, 2 were bronchoscopic biopsy, 1 was bronchoscopic biopsy, 1 was thoracoscopic lung biopsy. , Ascites cell mass examination in 1 case. The main symptoms were cough (7/9), sputum (3/9), fever (3/9) and wheezing (2/9). Chest CT showed pulmonary mass (3/9, 1 case of multiple), mediastinal lymph nodes (6/9), hilar lymph nodes (3/9), lung consolidation (3/9), pleural effusion (6/9, 3 cases bilateral), pleural thickening (2/9), atelectasis (2/9), patchy (7/9), pericardial effusion (1/9). Laboratory tests revealed that seven patients had elevated CA125 and four had elevated lactate dehydrogenase (LDH). 1 patient died during hospitalization, 1 patient was discharged automatically. One patient died during follow-up, and five patients were still under follow-up. Conclusion Lymphoma patients with atypical respiratory symptoms, chest imaging findings vary, CA125, LDH and other indicators to determine the condition and evaluate the prognosis may play a role.