艾滋病合并胃肠道淋巴瘤10例临床特征分析  

Clinical characteristics of AIDS complicated with gastrointestinal lymphoma

作　　者：钱娟 冉伟 陈龙 袁婧[1] QIAN Juan;RAN Wei;CHEN Long;YUAN Jing(Department of Infectious Disease,Chongqing Public Health Medical Center,Chongqing 400036,China)

机构地区：[1]重庆市公共卫生医疗救治中心感染科,重庆400036

出　　处：《中国感染与化疗杂志》2023年第6期681-685,共5页Chinese Journal of Infection and Chemotherapy

基　　金：重庆市科卫中医药技术创新与应用发展项目(2020ZY4094,2021ZY4265)。

摘　　要：目的了解艾滋病合并胃肠道淋巴瘤的临床特征,并复习相关文献,以提高对此类疾病的认识。方法回顾性分析2019年1月至2021年12月重庆市公共卫生医疗救治中心收治的10例艾滋病合并胃肠道淋巴瘤患者,结合临床症状、实验室检查及胃肠镜检查、病理结果、治疗及预后等资料进行分析。结果10例艾滋病合并胃肠道淋巴瘤均为男性,平均年龄(46.8±16.3)岁。8例患者CD4+T淋巴细胞计数<200个/μL。病变范围累及胃(7例)、结肠(2例)及直肠(1例),多部位活检病理证实10例患者均为非霍奇金淋巴瘤(包括弥漫大B细胞淋巴瘤8例、伯基特淋巴瘤1例及浆母细胞淋巴瘤1例)。临床症状无特异性,常见为纳差、腹胀、体重下降。胃淋巴瘤可同时累及多部位,最常见发病部位为胃体、胃窦,胃镜下表现为多个结节样隆起伴溃疡,胃内黏膜多处充血肿胀、糜烂。肠道淋巴瘤2例,发生在升结肠,受累管壁弥漫性充血、肿胀,局灶不规则溃疡。直肠1例,为巨大新生物,向肛门突出,表面糜烂,触之易出血,肠腔变窄。10例淋巴瘤患者根据Ann Arbor改良分期,确诊时Ⅱ期1例,Ⅲ期4例,Ⅳ期5例。接受化疗的7例因各种原因均未完成治疗,其中1例(病例9)虽只化疗了4个周期,但截至随访时患者疾病稳定,未进展;3例未接受化疗,其中1例失访,另外2例在确诊淋巴瘤后1个月内死亡。结论艾滋病合并胃肠道淋巴瘤好发于男性,且CD4+T淋巴细胞计数常小于200个/μL,以胃内高发,弥漫大B细胞淋巴瘤最为常见,临床分期为较晚期。胃肠镜对艾滋病合并胃肠道淋巴瘤诊断及鉴别诊断具有重要价值。规范化疗联合抗反转录病毒治疗可提高艾滋病合并胃肠道淋巴瘤患者的生存率。Objective To understand the clinical characteristics of AIDS complicated with gastrointestinal lymphoma and review the relevant literature in order to improve the awareness of this disease.Methods Ten AIDS patients complicated with gastrointestinal lymphoma admitted to Chongqing Public Health Medical Treatment Center from January 2019 to December 2021 were retrospectively analyzed.The clinical symptoms,laboratory tests,gastroscopy,pathological results,treatment and outcomes were analyzed accordingly.Results All the 10 patients were males,with an average age of(46.8±16.3)years.The CD4+T lymphocyte count was less than 200 cell/μL in 8 patients.The lesions involved the stomach(7 cases),colon(2 cases)and rectum(1 case).Non-Hodgkin lymphoma was confirmed in 10 patients,including 8 cases of diffuse large B-cell lymphoma,1 case of Burkitt's lymphoma,and 1 case of plasmablastic lymphoma.The clinical symptoms were nonspecific,including poor appetite,abdominal distension,and weight loss.Gastric lymphoma could involve multiple sites at the same time,mostly involving gastric body and gastric antrum.Multiple swelling nodules with ulcers,multiple sites of hyperemia,and swelling and erosion of gastric mucosa were observed under gastroscope.There were 2 cases of intestinal lymphoma in the ascending colon,with diffuse hyperemia and swelling of the involved intestinal wall and local irregular ulcer.One case of rectal lymphoma was manifested as a huge new neoplasm protruding to the anus,with erosion on the surface,readily to bleed,and narrowing of the intestinal lumen.According to the modified Ann Arbor staging system,the lymphoma belonged to stage II in 1 case,stage III in 4 cases,and stage IV in 5 cases.Seven patients received chemotherapy,but failed to complete the treatment due to various reasons.One patient(case 9)only received chemotherapy for 4 cycles,but the patient's disease was stable and did not progress until last follow-up visit.Three patients did not receive chemotherapy,one of whom was lost to follow-up,and the oth

关 键 词：艾滋病 非霍奇金淋巴瘤 胃镜 肠镜 

分 类 号：R512.91[医药卫生—内科学]