18例HIV感染相关淋巴瘤的临床特点分析  

Analysis of clinical features of HIV related lymphoma in 18 patients

作　　者：龚奕[1] 陈锐[2] 李光新[2] 李启英[1] 南映瑜[1] 项颖[1] 

机构地区：[1]重庆市肿瘤研究所/重庆市肿瘤医院血液肿瘤科,400030 [2]重庆市肿瘤研究所/重庆市肿瘤医院病理科,400030

出　　处：《检验医学与临床》2017年第9期1213-1214,1217,共3页Laboratory Medicine and Clinic

基　　金：重庆市卫生和计划生育委员会医学科研基金面上项目(2015MSXM224)

摘　　要：目的分析18例HIV感染相关淋巴瘤临床特点。方法通过回顾性分析重庆市肿瘤医院2010-2016年收治的HIV感染相关淋巴瘤临床资料,对患者一般情况、淋巴瘤国际预后指数(IPI)评分、CD4^+T淋巴细胞绝对值、血清乳酸脱氢酶(LDH)浓度、B症状、Ann Arbor分期、病变累及部位及病理类型等进行统计分析。结果 18例HIV感染相关淋巴瘤均为确诊为HIV感染的男性患者,平均年龄(48.6±13.97)岁。首发的临床症状主要为体表淋巴结肿大13例(72.22%)。病理诊断包括弥漫大B细胞淋巴瘤9例(50.00%),Burkitt淋巴瘤6例(33.33%),淋巴结边缘区淋巴瘤1例(5.56%),经典型霍奇金淋巴瘤1例(5.56%),霍奇金淋巴瘤1例(5.56%)。患者多表现为隐匿性起病,且诊断时分期较晚,Ⅲ~Ⅳ期患者占绝大多数,为14例(77.8%)。患者入院后根据病情需要接受了EPOCH方案、R-EPOCH方案、CHOP方案、CHOPE方案或ABVD方案等多种联合化疗方案+抗HIV治疗2程后,其中2例完全缓解,12例达部分缓解,3例为病情进展。主要不良反应为转氨酶升高和骨髓抑制。结论 HIV感染相关淋巴瘤总体预后不良,早期诊断和多学科联合积极规范化治疗是改善HIV感染相关淋巴瘤总体生存和生活质量的关键措施。Objective To study and analyze the clinical features of HIV related lymphoma in 18 patients.Methods The clinical data of HIV related patients who were admitted to Chongqing cancer hospital from 2010-2016 were collected and analyzed,and general situations,IPI score,lymphocyte absolute value of CD4＋T,lactate dehydrogenase level,B symptoms,Ann Arbor stage,lesion locations and pathological types were also analyzed.Results Of the total 18 cases,all were male HIV infected patients,and mean age was 48.6 years old.And lymphadenopathy was the most frequent preliminary manifestations [72.22% （13/18）].Definite pathological diagnosis included 8 cases with diffuse large B cell lymphoma （44.44%）,6 cases Burkitt lymphoma （33.33%）,1 case with nodal marginal zone lymphoma （5.56%） and 1 case with Classic Hodgkin lymphoma （5.56%）.Most patients demonstrated insidious onset of disease,and higher percentage of patients were Ann Arbor stage Ⅲ to Ⅳ [77.8%（14/18）].All patients accepted anti-HIV therapy plus various anti-lymphoma chemotherapy individually,including EPOCH,R-EPOCH,CHOP,CHOPE and ABVD.After two cycles of chemotherapy,2 patients achieved complete remission,12 patients achieved partial remission,and 3 patients with progressive disease were observed.The main adverse effects included elevated transaminase and bone marrow toxicity.Conclusion Although the prognosis of HIV-related lymphoma is generally poor,early diagnosis with multidisciplinary and individualized therapy is one of the key points to improve the overall survival and life quality of HIV related lymphoma patients.

关 键 词：HIV感染 淋巴瘤 获得性免疫缺陷综合征 回顾性研究 

分 类 号：R512.91[医药卫生—内科学]