PDF(Pubmed)
Abstract：
BACKGROUND: Cytokine storm is now considered to be a systemic inflammatory response, but local cytokine storm may exist in systemic diseases of the blood system. Monitoring of regional cytokine storm is an important clue for the diagnosis of systemic diseases.
METHODS: A 72-years-old male presented to our hospital with multiple serosal effusion without solid mass or enlarged lymph nodes. We found that the level of cytokines in ascites was tens to hundreds of times higher than that in plasma, mainly IL-6 and IL-8.
METHODS: The patient was diagnosed with multiple serous effusion, hemophagocytic syndrome, B-cell lymphoma, Epstein-Barr virus infection, and hypoproteinemia.
METHODS: During hospitalization, the patient was treated with 5 courses of R-CVEP therapy and supportive treatment.
RESULTS: After the first R-CVEP regimen, the patient\'s condition was evaluated as follows: hemophagocytic syndrome improved: no fever; Serum triglyceride 2.36 mmol/L; Ferritin 70.70 ng/L; no hemophagocyte was found in the bone marrow; the lymphoma was relieved, ascites disappeared, and bone marrow cytology showed: the bone marrow hyperplasia was reduced, and small platelet clusters were easily seen. Bone marrow flow cytometry showed that lymphocytes accounted for 13.7%, T cells increased for 85.7%, CD4/CD8 = 0.63, B cells decreased significantly for 0.27%, and NK cells accounted for 10.2%. Blood routine returned to normal: WBC 5.27 × 109/L, HB 128 g/L, PLT 129 × 109/L; Epstein-Barr virus DNA < 5.2E + 02 copies/mL; correction of hypoproteinemia: albumin 39.7 g/L.
CONCLUSIONS: Cytokines in ascites are significantly higher than those in plasma by tens to hundreds of times, suggesting that \"regional cytokine storms\" may cause serosal effusion.
METHODS: A 72-years-old male presented to our hospital with multiple serosal effusion without solid mass or enlarged lymph nodes. We found that the level of cytokines in ascites was tens to hundreds of times higher than that in plasma, mainly IL-6 and IL-8.
METHODS: The patient was diagnosed with multiple serous effusion, hemophagocytic syndrome, B-cell lymphoma, Epstein-Barr virus infection, and hypoproteinemia.
METHODS: During hospitalization, the patient was treated with 5 courses of R-CVEP therapy and supportive treatment.
RESULTS: After the first R-CVEP regimen, the patient\'s condition was evaluated as follows: hemophagocytic syndrome improved: no fever; Serum triglyceride 2.36 mmol/L; Ferritin 70.70 ng/L; no hemophagocyte was found in the bone marrow; the lymphoma was relieved, ascites disappeared, and bone marrow cytology showed: the bone marrow hyperplasia was reduced, and small platelet clusters were easily seen. Bone marrow flow cytometry showed that lymphocytes accounted for 13.7%, T cells increased for 85.7%, CD4/CD8 = 0.63, B cells decreased significantly for 0.27%, and NK cells accounted for 10.2%. Blood routine returned to normal: WBC 5.27 × 109/L, HB 128 g/L, PLT 129 × 109/L; Epstein-Barr virus DNA < 5.2E + 02 copies/mL; correction of hypoproteinemia: albumin 39.7 g/L.
CONCLUSIONS: Cytokines in ascites are significantly higher than those in plasma by tens to hundreds of times, suggesting that \"regional cytokine storms\" may cause serosal effusion.
摘要：
背景：现在认为细胞因子风暴是一种全身性炎症反应，但是局部细胞因子风暴可能存在于血液系统的全身性疾病中。监测区域性细胞因子风暴是诊断全身性疾病的重要线索。
方法：一名72岁男性患者，出现多发性浆膜积液，无实性肿块或肿大淋巴结。我们发现腹水中的细胞因子水平比血浆中的高几十倍到数百倍，主要是IL-6和IL-8。
方法：患者被诊断为多发性浆液性积液，噬血细胞综合征,B细胞淋巴瘤,EB病毒感染,和低蛋白血症。
方法：住院期间，患者接受了5个疗程的R-CVEP治疗和支持治疗.
结果：第一次R-CVEP治疗后，患者病情评估如下：噬血细胞综合征好转：无发热；血清甘油三酯2.36mmol/L；铁蛋白70.70ng/L；骨髓中无噬血细胞；淋巴瘤缓解，腹水消失了,骨髓细胞检查显示：骨髓增生减少，和小的血小板簇很容易看到。骨髓流式细胞术显示淋巴细胞占13.7%,T细胞增加85.7%,CD4/CD8=0.63,B细胞显著下降0.27%,NK细胞占10.2%。血常规恢复正常：WBC5.27×109/L，HB128g/L，PLT129×109/L;EB病毒DNA<5.2E+02拷贝/mL;纠正低蛋白血症:白蛋白39.7g/L
结论：腹水中的细胞因子明显高于血浆中的数十倍至数百倍，提示“区域性细胞因子风暴”可能导致浆膜积液。
方法：一名72岁男性患者，出现多发性浆膜积液，无实性肿块或肿大淋巴结。我们发现腹水中的细胞因子水平比血浆中的高几十倍到数百倍，主要是IL-6和IL-8。
方法：患者被诊断为多发性浆液性积液，噬血细胞综合征,B细胞淋巴瘤,EB病毒感染,和低蛋白血症。
方法：住院期间，患者接受了5个疗程的R-CVEP治疗和支持治疗.
结果：第一次R-CVEP治疗后，患者病情评估如下：噬血细胞综合征好转：无发热；血清甘油三酯2.36mmol/L；铁蛋白70.70ng/L；骨髓中无噬血细胞；淋巴瘤缓解，腹水消失了,骨髓细胞检查显示：骨髓增生减少，和小的血小板簇很容易看到。骨髓流式细胞术显示淋巴细胞占13.7%,T细胞增加85.7%,CD4/CD8=0.63,B细胞显著下降0.27%,NK细胞占10.2%。血常规恢复正常：WBC5.27×109/L，HB128g/L，PLT129×109/L;EB病毒DNA<5.2E+02拷贝/mL;纠正低蛋白血症:白蛋白39.7g/L
结论：腹水中的细胞因子明显高于血浆中的数十倍至数百倍，提示“区域性细胞因子风暴”可能导致浆膜积液。
