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目的对淋巴瘤合并周围神经病变的临床特点、辅助检查结果进行分析,并探讨其发病机制。方法回顾分析13例淋巴瘤合并周围神经病变患者诊断、治疗经过,排除继发性带状疱疹病毒感染、相关治疗的不良反应及其他导致周围神经病变的病因。其中T细胞性非霍奇金淋巴瘤(NHL-T)3例,B细胞性非霍奇金淋巴瘤(NHL-B)9例,1例具体病理类型不详。对其周围神经受累的类型和部位、脑脊液细胞学和免疫组织化学、影像学、电生理学以及腓肠神经活体组织病理学检查结果等进行分析。结果13例中10例周围神经系统症状出现于淋巴瘤明确诊断之前,其中8例以周围神经系统症状首发;11例脑神经受累,8例腰骶神经根受累,6例同时合并听力减退及腰骶神经根受累。脑脊液检查主要呈现蛋白定量(13例)、白细胞计数(8例)以及脑脊液压力(5例)升高,葡萄糖水平降低(7例);细胞学检查可见异型淋巴细胞(9例);免疫组织化学染色及基因重排检测主要表现为B细胞标记抗原(CD19、CD20、CD79α)阳性(3例),CD20阳性细胞数目增加(1例),以及CD4阳性细胞数目增加、T细胞(抗原识别)受体阳性和抗体IgH阴性(1例)。肌电图检查显示,周围神经轴索病变或合并髓鞘损害(9例)。腓肠神经活体组织病理学检查呈轴索变性和(或)脱髓鞘病变且无淋巴瘤细胞浸润(3例)。头部及腰骶部MRI检查显示,双侧听神经及马尾神经根增粗、强化或脑膜强化。13例中9例系由淋巴瘤细胞直接浸润脑脊膜神经根所致,1例为淋巴瘤转移和局部肿大淋巴结压迫引起,其余3例无明确肿瘤细胞浸润证据,结合临床特点和实验室检查结果,考虑副肿瘤综合征可能。结论淋巴瘤可通过肿瘤细胞直接浸润或副肿瘤综合征导致周围神经病变;周围神经系统症状在淋巴瘤明确诊断前即可出现,临床应对此提高认识。
Objective To analyze the clinical features and auxiliary examinations of lymphoma with peripheral neuropathy and to explore its pathogenesis. Methods Retrospective analysis of 13 cases of lymphoma with peripheral neuropathy in patients with diagnosis and treatment after the removal of secondary herpes zoster virus infection, the adverse reactions associated with treatment and other causes of peripheral neuropathy. Among them, 3 were T cell non-Hodgkin’s lymphoma (NHL-T) and 9 were B cell non-Hodgkin’s lymphoma (NHL-B). One patient had no specific pathological type. The type and location of peripheral nerve involvement, cerebrospinal fluid cytology and immunohistochemistry, imaging, electrophysiology and supine nerve tissue histopathological examination results were analyzed. Results Ten cases of peripheral nervous system were found in 13 cases prior to the definite diagnosis of lymphoma. Eight cases were diagnosed with peripheral nervous system symptoms. Eleven patients suffered from cranial nerve involvement, eight patients with lumbosacral nerve root involvement, six patients with concurrent hearing impairment and lumbar Sacral nerve root involvement. Cerebrospinal fluid examination mainly showed protein quantification (13 cases), leukocyte count (8 cases) and cerebrospinal fluid pressure (5 cases), and glucose level decreased (7 cases). Cytological examination revealed allogenic lymphocytes (9 cases); immunohistochemistry The results of staining and gene rearrangement showed that B cell antigen (CD19, CD20, CD79α) was positive (3 cases), CD20 positive cells (1 case), CD4 positive cells increased, T cells (antigenic recognition) Positive for body and negative for IgH (1 case). EMG examination showed peripheral axonal lesions or myelin damage (n = 9). Sural nerve biopsies were axonal degeneration and / or demyelinating lesions without lymphoma cell infiltration (3). Head and lumbosacral MRI examination showed bilateral auditory nerve and cauda equina root thickening, strengthening or meningeal enhancement. Of the 13 cases, 9 cases were caused by the direct infiltration of lymphoma cells into the nerve root of the cutaneous nerve root. One case was caused by lymphatic metastasis and local lymph node compression. The remaining three cases had no evidence of tumor cell infiltration. Combined with clinical features and laboratory Check the results, consider the possibility of paraneoplastic syndrome. Conclusion Lymphomas can cause peripheral neuropathy by direct infiltration of tumor cells or paraneoplastic syndrome. Peripheral nervous system symptoms may appear before the definite diagnosis of lymphoma, which should be improved clinically.