胃黏膜相关淋巴组织淋巴瘤的循证诊疗:附病例报告

目的借助循证医学方法为一例胃黏膜相关淋巴组织(MALT)淋巴瘤患者确定治疗方案。方法在充分评估患者情况后,按照PICO原则提出临床问题并转化,计算机检索Cochrane Library、Medline、EMBase、维普资讯、万方数据库及中国知网,检索年限均为1990—2011年,收集相关高质量证据进行评价,并结合医生经验及患者愿望制定治疗方案。结果共纳入21篇文献,其中系统评价或Meta分析4篇,随机对照试验(RCT)9篇,病例报告8篇。结果显示,对于幽门螺杆菌(Hp)(+)的早期胃MALT淋巴瘤患者,首选Hp根除治疗。对于早期胃MALT淋巴瘤,化疗是有效的一线治疗。对于根除Hp无效的胃MALT淋巴瘤,放疗效果较为明显。化疗后手术治疗并不能提高早期高度恶性胃MALT淋巴瘤患者的预后,单纯化学治疗即可达到同样的效果。根据以上证据并结合患者意愿,对该例患者采用根除Hp三联疗法,治疗4周后,患者临床症状得到明显缓解,Hp、内镜检查结果均为阴性。结论 Hp(+)的早期胃MALT淋巴瘤患者,首选根除Hp治疗,可有效提高疗效和患者生活质量,但远期效果仍需进一步观察。

Evidence-Based Treatment for Gastric MALT Lymphoma:A Case Report

Objective To make an individualized evidence-based treatment plan for a patient with gastric MALT lymphoma.Methods After comprehensively evaluating the condition of the patient,we put forward our clinical problems according to PICO principle and searched the internet to collect high-quality evidence from the Cochrane Library,Medline,and EMBase,retrieval time being 1990—2011.The treatment plan was designed based on the evaluation of evidence,doctor′s experience and patient′s preferences.Results A total of 4 meta-analyses or systematic reviews,9 RCTs and 8 case reports were included.The evidence showed that the eradication of Hp infection treatment was the first choice for Hp positive early gastric MALT lymphoma.For early gastric MALT lymphoma,chemotherapy was an effective first-line treatment.Radiotherapy was more effective for the gastric MALT lymphoma after failure of eradication of Hp infection.Surgery after chemotherapy can not improve the prognosis of the early high grade gastric MALT lymphoma,while chemotherapy alone can achieve the same effect.Based on the evidences above and patient′preferences,triple therapy for eradication of Hp was adopted to treat the patient.After 4 weeks of treatment,the clinical symptoms were remarkably alleviated and Hp and endoscope all turned negative.Conclusion The eradication of Hp infection treatment,the first choice for Hp positive early gastric MALT lymphoma,can improve the clinical outcomes and patient′s quality of life.However,long-term prognostic benefits need to be confirmed by further observation.