有效治疗艾滋病伴发的Kaposi肉瘤1例

Effecttive Treatment of AIDS with Kaposi's Sarcoma

患者男,48岁。HIV抗体阳性3年余,伴颜面、口腔散在紫红色斑疹、结节2个月。患者3年前接受ART治疗(AZT+3TC+EFV),治疗4个月后自行停药。2个月前颜面、口腔出现散在紫红色斑疹、结节,至本院治疗。皮肤科情况:右侧颜面部、鼻尖、大小不等紫红色斑疹、结节,鼻尖部皮损有卫星灶,口腔上腭黏膜可见大片紫色斑疹,中央有糜烂;左侧颈部、颌下可触及皮下结节。皮损组织病理示:(颜面部)真皮层内成片血管增生,管腔大小不等、扩张、充血,内皮细胞形态饱满,血管周围见少许嗜酸性梭形细胞。免疫组织化学示:Vimentin(+),CD31(+),CD34(2+),FVⅢ(+),Ki67(+10%),S-100(-),SMA(-),Desmin(-);诊断。艾滋病;Kaposi肉瘤。住院期间给予常规三次"ABV"(阿霉素+博来霉素+长春新碱)化疗、冷冻治疗及对症支持治疗后,患者各部位皮损消退不明显。再次入院后,联合更昔洛韦钠和短效干扰素治疗。皮损明显消退,未复发。

A 48-year-old male were confirmed with positive HIV antibody for more than three years,accompanied with purple-red spots and nodules in his face and mouth for more than two months. The patient accepted ART treatment( AZT + 3 TC + EFV) three years ago,and stop the drug by himself after four months treatment. When his face and mouth appeared scattered purple-red rash and nodules,he came to be treated in our hospital. Dermatological examination showed that the right side of the face and nose appeared purple-red unequal-sized spots and nodules,nasal tip lesions presented satellite shape,and oral mucosa can be seen large purple spots with the central erosion. The left neck and submandibular could reach the subcutaneous nodules. Lesion histopathology showed: vascular hyperplasia in the dermis,dilation and hyperemia in the channel,plump endothelial cells,and a small number of spindle cells around the blood vessels. The immunohistochemistry showed: Vimentin( +),CD31( +),CD34( + +),FVIII( +),Ki67( + 10%),S-100(-),SMA(-),Desmin(-). Diagnosis: AIDS combined with Kaposi sarcoma. During the hospitalization,the patients were treated with " ABV"( adriamycin + bleomycin + vincristine) chemotherapy,cryotherapy and related symptomatic support treatments. However,the lesion had no improvement. Ganciclovir sodium combined short-acting interferon were given to thepatients on his next admission,and the treatment was effective without recurrence.