胡振.以高钙血症为首发表现的高龄老年弥漫大B细胞淋巴瘤4例临床分析并文献复习[J].内科急危重症杂志,2017,23(3):
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| 中文关键词: 弥漫大B细胞淋巴瘤 高钙血症 意识障碍 |
| 英文关键词:diffuse large B cell lymphoma hypercalcemia conscious disturbance |
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| 中文摘要: |
| 【】目的 分析高龄和非高龄弥漫大B细胞淋巴瘤伴高钙血症患者的临床特点,提高认识。方法 报道北京医院诊治的4例高龄老年弥漫大B细胞淋巴瘤伴高钙血症病例的临床表现、治疗经过和病情转归,并结合国内外报道的37例临床资料,比较高龄(大于等于75岁)和非高龄患者临床特点的差异。结果 男22例,女19例。年龄为24-90岁,平均(65±16)岁。首发表现前三位包括意识改变(46%),局部疼痛(32.4%),恶心(18.9%)。高龄患者的血钙浓度值较非高龄患者低[(3.67±0.33)vs (4.33±1.02)mmol/L,P<0.05]。高龄患者骨侵犯的发生率较非高龄患者明显降低[(2/10)vs(12/16),P<0.05]。高龄患者的1,25-羟基维生素D3升高发生率高于非高龄患者[(7/9)vs(1/7),P<0.05]。高龄患者的PTHrP升高发生率低于非高龄患者[(4/10)vs(9/10),P<0.05]。LDH在所有病例(22/22)中均升高。高龄患者的化疗缓解率低于非高龄患者[(4/11)vs(10/13),P<0.05]。高龄患者生存时间低于非高龄患者[1(0.8,2.75)月vs 8(6.5,15)月,P<0.05]。结论 弥漫大B细胞淋巴瘤合并高钙血症临床少见,高龄患者较非高龄患者预后更差。高钙血症临床表现缺乏特异性,以高钙血症为首发表现的病例要警惕淋巴瘤可能。 |
| 英文摘要: |
| Objective To analysis the clinical manifestation and pathogenesis of hypercalcemia which antedates diffuse large B cell lymphoma .Methods We presented 4 diagnosed cases of hypercalcemia which antedates diffuse large B cell lymphoma in Beijing hospital and reviewed 37 cases of diffuse large B cell lymphoma complicated hypercalcemia previously reported in China and abroad.The differences of clinical features were compared between the senility(older than 75 years old) and non-senility patients．Results Of the 41 patients in total,there were 22 males and 19 females,with a mean age of(65±16)years.The top three svmptoms were altered consciousness(46％),local pain (32.4％)and nausea(18.9％).The level of blood calcium was lower in senility than in non-senility[(3.67±0.33)vs (4.33±1.02)mmol/L,P<0．05].The incidence of bone metastasis was lower in senility than in non-senility[(2/10)vs(12/16),P<0.05].The incidence of elevated 1,25-dihydroxy vitamin D was higher in senility than in non-senility[(7/9)vs(1/7),P<0.05].The incidence of elevated PTHrP was lower in senility than in non-senility[(4/10)vs(9/10),P<0.05].LDH was elevated in every recorded patien(22/22).The incidence of chemotherapy remission was lowerer in senility than in non-senility[(4/11)vs(10/13),P<0.05].The survival time was less in senility than in non-senility[1(0.8,2.75)月vs 8(6.5,15)月,P<0.05]. Conclusions Diffuse large B cell lymphoma complicated hypercalcemia is not frequent, the prognosis is poorer in senility.Hypercalcemia can perform nonspecific manifestation.When a patient present with hypercalcemia,we should be vigilant of lymphoma. |
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