艾滋病合并淋巴瘤10例临床分析  

Clinical Analysis of 10 Cases of AIDS Complicated with Lymphoma

作　　者：裴强[1] 韩潇[1] 张炎[1] 张薇[1] 周道斌[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血液科,北京100730

出　　处：《中国实验血液学杂志》2018年第1期146-152,共7页Journal of Experimental Hematology

摘　　要：目的:探讨艾滋病相关淋巴瘤(ARL)患者的临床特点,提高对该病的认识。方法:回顾分析10例ARL患者的临床特点、病理结果、治疗及预后。结果:10例ARL患者中9例为男性,1例为女性,中位年龄42岁。10例患者中6例患者在确诊AIDS并治疗后7-48个月内发生淋巴瘤,1例患者确诊后未治疗且48个月后发生淋巴瘤症状,3例患者在淋巴瘤诊治过程中发现HIV感染。8例(8/10)患者有结外受累。就诊时CD4^+T细胞中位计数255(69-232)×10~6/L。6例行抗高效逆转录病毒治疗(HAART)患者的HIV病毒载量均低于测量下限,无抗病毒史患者HIV RNA拷贝数为0-45000拷贝/ml。起病时伴发热患者4例(4/10),以局部肿块起病者6例(6/10),2例(2/10)以咽痛、咽部溃疡起病。10例病理类型中7例为B细胞来源,其中5例为弥漫大B细胞淋巴瘤,1例霍奇金淋巴瘤,1例Bur Kitt淋巴瘤;余3例为T细胞淋巴瘤。9例患者同时接受化疗和HAART治疗,化疗后未出现严重不良反应。患者CR率67%,中位无疾病进展时间为14个月,中位生存时间为21个月。结论:ARL临床表现多样,积极的HAART联合规范性化疗可能改善ARL患者的预后。Objective： To investigate the clinical features and treatment of the patients with AIDS-related lymphoma（ ARL）. Methods： The clinical data,pathology,treatment and prognosis of patients with ARL were retrospectively analyzed. Results： Among 10 cases of ARL,9 were male and 1 was female. The median age was 42 years old.Lymphoma occurred in 6 patients after diagnosis as AIDS,and treatment for 7-48 months,1 case among which was diagnosed but not treated,then the lymphomatous symptions appeared after 48 months; 3 patients were found to have HIV infection during the diagnosis and treatment of lymphoma. Eight patients（ 8/10） had extranodal involvement. The count of CD4~＋T cells was（ 69-601） × 106/L at presentation,the median count was 255 × 10~6/L,HIV viral loads of 6 patients underwent antiretroviral therapy were lower than the lower-limit when diagnosed,while the RNA HIV copies of other patients were 0-45000 copies/ml. Four patients（ 4/10） displayed fever,6（ 6/10） with local mass,2 with sore throat and throat ulcer. The pathological types of 7 cases were B cell-originated,including 5 cases of diffuse large B cell lymphomas（ DLBCL）,1 case of Hodgkin＇s lymphoma and 1 cases of Burkitt＇ s lymphoma. The other 3 cases were T cell lymphomas. Nine patients received chemotherapy and antiretroviral therapy at the same time. There were no serious adverse reactions after chemotherapy. The CR rate was 67%,the median progression-free survival（ PFS） was 14 months,the median survival time was 21 months. Conclusion： Clinical manifestations of ARL patients are diverse,chemotherapy combined with antiretroviral therapy may improve the prognosis.

关 键 词：获得性免疫缺陷综合征 淋巴瘤 化疗 预后 

分 类 号：R512.91[医药卫生—内科学] R733.1[医药卫生—临床医学]