新疆地区70例艾滋病相关型卡波西肉瘤患者临床特征及预后分析  

Clinical features and prognosis of AIDS-related Kaposi＇s sarcoma： a retrospective study in 70 patients in Xinjiang

作　　者：杨彤彤[1] 万学峰[2] 宋玉霞 买买提艾力·吾不力[1] 潘珂君[1] 鲁晓擘[1] 张跃新[1] 

机构地区：[1]新疆医科大学第一附属医院感染科,乌鲁木齐830054 [2]新疆医科大学第一附属医院皮肤科,乌鲁木齐830054 [3]新疆维吾尔自治区第六人民医院感染科

出　　处：《中华临床感染病杂志》2014年第5期431-436,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金资助项目（81060131、81260246）

摘　　要：目的 分析新疆艾滋病相关型卡波西肉瘤（AIDS-KS）患者的临床特征,探讨抗反转录病毒治疗（HAART）及系统性化疗等对患者预后的影响.方法 连续收集2008年1月至2013年6月新疆维吾尔自治区第六人民医院收治的70例AIDS-KS患者的临床资料,采用回顾性研究的方法对人群特点、KS进展情况、病变部位及范围、治疗及预后等进行总结分析,并采用t检验和x2检验比较不同治疗组的疗效及预后.结果 70例AIDS-KS患者的平均年龄为（40±10）岁,男女比例2.5∶1,其中66例（94.29％）为维吾尔族,23例（32.9％）疾病进展评分为快速.KS临床症状主要有斑片、结节等,且头颈、躯干、四肢和内脏均有累及.治疗组总病死率为7.7％ （4/52）,而未治疗组的12例患者中4例死亡,与治疗组比较差异有统计学意义（x2=5.861,P＜0.05）.单纯HAART组和HAART序贯化疗组治疗半年后CD4＋T淋巴细胞计数较治疗前明显上升（t=35.258和42.528,P＜0.01）,而采用其他治疗方案的患者和未治疗的患者CD4＋T淋巴细胞计数较治疗前无显著变化或下降.HAART序贯化疗组、化疗序贯HAART组和单纯化疗组中的所有患者对KS治疗均有效,而单纯HAART组的治疗有效率为86.4％ （19/22）,且45.5％ （10/22）的患者在HAART后出现免疫重建炎症反应综合征（IRIS）,KS症状加重.结论 AIDS-KS多发生于中青年,以维吾尔族男性多见,病灶部位多样化,部分呈快速进展.HAART联合系统性化疗疗效较好,且可降低IRIS的发生率,值得临床推广应用.Objective To analyze the clinical features of AIDS-related Kaposi＇s sarcoma （AIDSKS） patients in Xinjiang uygur autonomous region,and to evaluate the efficacy of highly active antiretroviral therapy （HAART） and systemic chemotherapy.Methods Clinical data on 70 AIDS-KS patients admitted in Sixth People＇ s Hospital of Xinjiang Uygur Autonomous Region from January 2008 to June 2013 were reviewed.The demographic characteristics,progress of KS,extent of lesions,treatment and prognosis of these patients were retrospectively studied.The efficacy of different therapies and the prognosis were compared using t or x2 test.Results The average age of 70 AIDS-KS patients was （40 ± 10） years,and the ratio of male and female was 2.5 ∶ 1.Sixty-six out of 70 （94.29％） patients were Uyghur ethnic.Among 70 patients,23 cases （32.9％） were rapidly progressed.Lesions often progress to plaques and nodules affecting head,neck,trunk,limbs and internal organs.Among 64 evaluable cases,the fatality rate in treatment group was 7.7 （4/52）,which was significantly lower than that in patients who did not receive treatment （4/12,x2 =5.861,P ＜ 0.05）.After 6-month of HAART or HAART sequenced by chemotherapy,CD4＋ T lymphocyte counts were significantly increased （t =35.258 and 42.528,P ＜0.01）,while it was decreased or remained in low level in patients received other treatments or untreated.HAART sequenced by chemotherapy,chemotherapy sequenced by HAART,and chemotherapy alone were effective for all AIDS-KS patients,while the effective rate in patients received HAART alone was 86.4％ （19/22）,and immune reconstitution inflammatory syndrome （IRIS） was appeared in 45.5％ （10/22）patients.Conclusions AIDS-KS more frequently occurs in young Uighur males.The lesion may affect various organs,and some progress rapidly.HAART plus chemotherapy may reduce the incidence of IRIS and improve the prognosis.

关 键 词：肉瘤 卡波西 获得性免疫缺陷综合征 临床特征 预后 

分 类 号：R512.91[医药卫生—内科学]