免疫缺陷与艾滋病相关淋巴瘤的临床分析

Clinical analysis of immune deficiency with acquired immune deficiency syndrome-related lymphoma

目的探讨艾滋病相关淋巴瘤的免疫功能与临床特点。方法人类获得性免疫缺陷病毒(HIV)感染合并淋巴瘤患者13例,均为男性,年龄25～66岁。在手术前后检测患者的免疫功能,规范手术操作程序,精细操作减少手术损伤,对合并血友病的患者术中持续静脉输注凝血因子Ⅷ,常规应用抗生素预防感染,及时处理并发症。给予高效价抗反转录病毒治疗和环磷酰胺+多柔比星+长春新碱+泼尼松(CHOP)方案全身化疗。结果手术均顺利,仅1例患者伤口感染,无严重手术并发症。患者手:术前CD4 T淋巴细胞为(178.3±106.6)个/μL,术后2周复查为(171.6±115.4)个/μL,差异无统计学意义(P>0.05)。3例患者在术后3～7个月死亡,另10例患者随访3～26个月,生存良好。结论艾滋病相关淋巴瘤患者的免疫功能低下,CD4 T淋巴细胞计数明显低于正常人群。持续抗逆转录病毒治疗可使免疫功能重建,手术切除病灶明确病理诊断,合适的化疗加综合治疗可取得较好的疗效。

Objective To explore clinical characteristics of acquired immune deficiency syndrome （AIDS）-related lymphoma and immune function. Methods The perioperative immune functions of 13 patients （all males, 25--66 years） with AIDS-related lymphoma were investigated. Surgical procedures were standardized and precise performance was used to avoid the surgical trauma. For the hemophilia patients, blood coagulation factor was infused continuously. And antibiotics were conventionally used to prevent infection. Prompt treatments had to be taken to deal with complications. Highly active antiretroviral therapy （HAART） and CHOP （cyclophosphamide, doxorubicin, oncovin prednisone）regimens were given. Results All the operations were successfully performed and no severe operative complications happened. Incision was infected only in one patient. CD4 T lymphocytes were （ 178.3 ± 106.6）/pL before operation and （ 171.6 ± 115.4）/pL 2 weeks after operation （ P 〉0.05）. Among the 13 patients, three died 3 to 7 months after operation, and the other ten survived well during a followup of 3 to 26 months. Conclusion The patients with AIDS-related lymphoma usually have immunological dysfunction. CD4 T lymphocyte count in the patients is less than that in the healthy persons. HAART can help reconstruct immune function. Lesions identified by pathological diagnosis need to be removed. Proper chemotherapy and comphrehensive treatment may obtain satisfactory effect for AIDS-related lymphoma.