淋巴瘤化疗后并发间质性肺炎72例临床分析

目的通过总结分析淋巴瘤患者化疗后间质性肺炎发生的临床特点和治疗转归,以加强对该病的预防并提高治疗效果。方法回顾性地分析近5年来经治的72例淋巴瘤患者化疗后发生间质性肺炎的相关因素、临床特征和治疗转归规律,总结甲基强的松龙冲击治疗的疗效和副作用。结果 72例患者中,有55例同时接受了含蒽环类和环磷酰胺方案的化疗,其中含CD20单抗者31例,含有博莱霉素者19例。72例患者均给予糖皮质激素治疗,其中65例联用了抗生素治疗,7例仅给予激素治疗。有50例经激素等治疗后病情逐步好转,另有22例患者经激素治疗后好转,但在激素减量或停用后间质性肺炎再复发加重,其中16例再次给予激素治疗仍然有效,另6例后期合并严重的肺部混合性感染和呼吸衰竭而死亡。结论淋巴瘤患者化疗后并发质性肺炎可能与环磷酰胺、博莱霉素等细胞毒化疗药物所致肺损伤和化疗及利妥昔单抗导致机体免疫失调等相关,早期激素治疗能有效缓解患者的症状和病情。

Drug-induced interstitial pneumonia:clinical analysis of 72 cases of malignant lymphoma

Objective To summarize the clinical features and treatment outcome of lymphoma patients with interstitial pneumonia after chemotherapy,and to improve the effect of prevention and treatment of lymphoma.Methods A retrospective analysis was conducted of 72 cases of lymphoma patients after chemotherapy in our department during the past five years.The interstitial pneumonia related factors,clinical features and treatment outcome,and methylprednisolone treatment efficacy and side effects were reviewed.Results Among the 72 cases,55 cases received anthracyclines and cyclophosphamide chemotherapy regimens,31 of whom were also treated with CD20 monoclonal antibody,and 19 cases with bleomycin.All the 72 cases were treated with corticosteroids,including 65 cases associated with antibiotic treatment,and 7 cases given corticosteroids treatment alone.The symptoms of 50 cases with corticosteroids treatment gradually improved,and 22 patients improved after corticosteroids treatment,but after the reduction of corticosteroids,the interstitial pneumonia relapsed again,16 cases of whom were still responsive to treatment again while the other six cases died with severe pulmonary mixed infections and respiratory failure.Conclusion Interstitial pneumonia among lymphoma patients after chemotherapy may be related to the lung injury by cyclophosphamide,bleomycin and other cytotoxic chemotherapy drugs,and to the immune disorders by chemotherapy and rituximab related.Corticosteroids therapy can effectively relieve the patient′s early symptoms.