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目的探讨小儿非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)的临床表现及预后危险因素。方法收集2006年3月至2012年10月期间初治的81例NHL患儿的资料。采用Kaplan-Meier进行生存分析,统计5年总生存率及无复发生存率。采用卡方检验分析不同临床因素与生存率的关系。采用多因素Logistic回归分析NHL的预后危险因素。结果 81例患儿包括23例前驱淋巴母细胞型,11例成熟T/NK淋巴细胞型,47例成熟B淋巴细胞型;其中以Burkitt淋巴瘤所占比例最高(35.80%)。前驱淋巴母细胞肿瘤患儿主要以外周淋巴结肿大(43.78%)为首发表现;成熟T/NK淋巴细胞肿瘤患儿主要以纵隔受累(45.45%)为首发表现;成熟B细胞肿瘤患儿中,29例Burkitt淋巴瘤患儿主要以腹腔受累(41.40%)为首发表现,15例弥漫性大细胞淋巴瘤患儿以腹部肿块(60.00%)为首发表现。77例患儿(4例放弃治疗)经治疗后,90.91%完全缓解,5.19%部分缓解,2.60%治疗后复发,1.30%出现中枢神经系统浸润。76例患者完成随访,5年的总生存率为67.11%,5年无复发生存率为63.16%。B症状、乳酸脱氢酶水平、临床分期是影响患儿5年总生存率及无复发生存率的因素(P均<0.05)。乳酸脱氢酶(LDH)≥500 U/L(OR:3.294)、临床晚期(Ⅳ期)(OR:2.756)是影响患儿预后的独立危险因素(P<0.05)。结论儿童NHL的临床表现呈多样化,LDH水平及临床分期是影响预后的独立危险因素,可以为早期治疗提供一定的参考。
Objective To investigate the clinical manifestations and risk factors of non-Hodgkin lymphoma (NHL) in children. Methods The data of 81 newly diagnosed NHL patients from March 2006 to October 2012 were collected. Survival analysis was performed with Kaplan-Meier, and the 5-year overall survival and recurrence-free survival were calculated. Chi- square test was used to analyze the relationship between different clinical factors and survival rate. Multivariate logistic regression analysis was used to analyze the prognostic risk factors of NHL. Results 81 cases of children including 23 cases of precursor lymphoblastic type, 11 cases of mature T / NK lymphocyte type, 47 cases of mature B lymphocyte type; Burkitt lymphoma accounted for the highest proportion (35.80%). Lymphoblastic tumor in children with predominant lymphadenopathy (43.78%) as the first manifestation; mature T / NK lymphoma in children with mediastinal involvement (45.45%) as the first performance; mature B cell tumor in children, In the 29 cases of Burkitt’s lymphoma, the first manifestation was intraperitoneal involvement (41.40%). Fifteen cases of diffuse large cell lymphoma were diagnosed by abdominal mass (60.00%). After treatment, 77 children (4 give up treatment), 90.91% complete remission, 5.19% partial remission, 2.60% recurrence after treatment, 1.30% central nervous system infiltration. 76 patients completed the follow-up, 5-year overall survival was 67.11%, 5-year recurrence-free survival rate was 63.16%. B symptoms, lactate dehydrogenase level, clinical stage are the factors that affect the 5-year overall survival and recurrence-free survival of children (all P <0.05). Lactate dehydrogenase (LDH) ≥500 U / L (OR: 3.294), clinical stage Ⅳ (OR: 2.756) were independent risk factors for prognosis of children (P <0.05). Conclusion The clinical manifestations of children with NHL are diversified. The level of LDH and clinical stage are independent risk factors for prognosis, which may provide some reference for early treatment.