非小细胞肺癌合并HIV感染/AIDS手术患者病理和临床特征及术后并发症影响因素分析  

Analysis of pathological and clinical characteristics and factors affecting postoperative complications in surgical patients with non-small cell lung cancer with HIV infection/AIDS

作　　者：王宁 李刚 龚胜 宋毅杰 李丹 刘玉 唐静 陈朝琼 蒋良双 姚晓军 Wang Ning;Li Gang;Gong Sheng;Song Yijie;Li Dan;Liu Yu;Tang Jing;Chen Zhaoqiong;Jiang Liangshuang;Yao Xiaojun(School of Public Health,Chengdu Medical College,Sichuan Chengdu 610083,China;Department of Thoracic Surgery,Public Health Clinical Center of Chengdu,Sichuan Chengdu 610061,China)

机构地区：[1]成都医学院公共卫生学院,四川成都610083 [2]成都市公共卫生临床医疗中心胸外科,四川成都610061

出　　处：《新发传染病电子杂志》2024年第2期29-33,共5页Electronic Journal of Emerging Infectious Diseases

基　　金：成都市医学科研课题(2020009)。

摘　　要：目的分析非小细胞肺癌(non-small cell lung cancer,NSCLC)合并HIV感染/AIDS手术病理及临床特征和术后并发症的影响因素,为临床治疗决策提供依据。方法本研究回顾性分析2018年9月至2022年12月在成都市公共卫生临床医疗中心胸外科接受手术的NSCLC合并HIV感染/AIDS患者的病理及临床资料,探究病理及临床特征和术后并发症的危险因素。结果本研究共纳入50例患者,平均年龄(56.86±8.89)岁,其中男性占74.00%,女性占26.00%。腺癌占72.00%,鳞癌占28.00%。29例患者行基因检测及细胞程序性死亡配体1(programmed cell death ligand 1,PD-L1)蛋白检测,EGFR突变率62.06%、KRAS突变率17.24%、BRAF突变率6.90%、ALK突变率3.45%;PD-L1蛋白检测阳性率20.69%(6/29)。术后并发症发生率38.00%(19/50),其中肺部感染14例、肺不张2例、脓气胸1例、乳糜胸2例。通过多因素Logistic回归分析提示术前抗病毒治疗时间≤4周、HIV载量≥40×10^(3)copy/L、CD4^(+)T淋巴细胞计数<200×10^(6)/L为术后并发症的独立危险因素(P<0.05)。结论通过有效抗病毒治疗,保持较高的CD4^(+)T淋巴细胞计数和较低的HIV载量,能有效减少NSCLC合并HIV感染/AIDS患者手术治疗的术后并发症。Objective To analyse the influencing factors of pathological and clinical characteristics and postoperative complications in patients with non-small cell lung cancer with HIV infection/AIDS.Method In this study,the pathological and clinical data of NSCLC patients with HIV infection/AIDS who underwent surgery in the Thoracic Surgery Department of Chengdu Public Health Clinical Medical Center from September 2018 to December 2022 and the pathological and clinical characteristics and risk factors of postoperative complications were analyzed.Result A total of 50 patients were included in this study,with a mean age of (56.86±8.89) years,of whom 74.00% were male and 26.00% were female.Adenocarcinoma accounted for 72.00%,and squamous carcinoma accounted for 28.00%.29 patients underwent genetic testing and PD-L1 protein testing,and the mutation rate of EGFR was 62.06%,the mutation rate of KRAS was 17.24%,the mutation rate of BRAF was 6.90% and the mutation rate of ALK was 3.45%,and the positive rate of PD-L1 protein testing was 20.69% (6/29),and the rate of postoperative complications was 38.00% (19/50).including 14 cases of lung infection,2 cases of pulmonary atelectasis,1 case of pyothorax,and 2 cases of coeliac chest.The duration of preoperative antiretroviral therapy ≤4 weeks,HIV load ≥40×10^(3 )copy/L,and CD4^(+) T lymphocyte count <200×10^(6)/L were suggested to be independent risk factors for postoperative complications by multifactorial logistic regression analysis (P<0.05).Conclusion Maintaining a high CD4^(+)T lymphocyte count and low HIV load through effective antiretroviral,it is effective in reducing postoperative complications of surgical treatment in patients with NSCLC combined with HIV infection/AIDS.

关 键 词：非小细胞肺癌 人类免疫缺陷病毒 术后并发症 影响因素 

分 类 号：R522[医药卫生—内科学] R654.7[医药卫生—临床医学]