13例AIDS合并非霍奇金淋巴瘤的临床分析

Clinical analysis of 13 AIDS patients complicated with non-Hodgkin lymphoma

目的分析13例艾滋病相关非霍奇金淋巴瘤（ARL）病人的临床资料,探讨其治疗时机和治疗方案。方法采用回顾性分析的方法,对龙潭医院2008年10月至2013年6月收治的艾滋病（AIDS）合并ARL住院病人的临床特点、免疫水平、并发症、病理检查及治疗情况、转归等进行分析。结果 13例ARL病人中,男性11例,女性2例,年龄24~71岁。10例在淋巴瘤诊治中首次发现艾滋病病毒（HIV）感染,2例分别在抗病毒治疗（ART）1个月和4个月后发现ARL,1例在诊断HIV感染后4个月发现ARL（未行ART）。发病时CD＋4T淋巴细胞计数为21~340个/μL。10例为B细胞淋巴瘤,其中1例为Burkitt淋巴瘤,1例为黏膜相关性淋巴样组织淋巴瘤（MALT）,6例为弥漫大B细胞性淋巴瘤,2例未能进一步分型;2例未分型,1例为T细胞淋巴瘤。以颈部肿物、腹股沟肿物、腋下包块、盆腔肿块及锁骨上肿物等为首发症状的7例,上消化道出血、便血、腹胀及腹痛、吞咽时胸骨后灼热痛、发热伴咽痛、发热伴头痛等起病6例。8例进行了ART,4例进行了化疗。4例未随访,7例死亡。结论HIV感染者若出现不明原因的淋巴结肿大、发热、消化道出血等,应考虑并发淋巴瘤的可能,必要时行淋巴结活检以明确诊断。积极的ART联合规范性化疗,以及适当的治疗时机仍需要补充更多的临床实践资料进行讨论。

Objective To analyze the clinical data of 13 AIDS patients complicated with non-Hodgkin lymphoma （NHL） and explore its treatment time and regimens. Methods The clinical data were analyzed in AIDS patients complicated with NHL admitted to Guangxi Zhuang Autonomous Region Longtan Hospital from Oct 2008 to Jun 2013. Results Of the 13 patients, 11 were male and 2 were female, with the age of 24 to 71 years old. Ten were found HIV positive during lymphoma diagnosis and treatment. One was diagnosed with AIDS related non-Hodgkin lymphoma （ARL） after 1 month of ART, another was after 4 months of ART, and the other was diagnosed with ARL at 4 months of AIDS diagnosis but not on ART. CD4＋ T cell counts were 21-340 cells/μL at the onset of illness. Pathological analysis showed that ten patients had B cell lymphoma, including one Burkitt lymphoma, one MALT lymphomas, six diffuse large B cell lymphomas, and 2 cases failed to further classification. Two cases were unclassified and one was T-cell lymphoma. Neck groin, armpit, pelvic and supraclavicular masses were the first symptom in 7 cases. Upper gastrointestinal bleeding, blood in the stool, bloating and abdominal pain, sternum burning pain when swallowing, fever and sore throat, fever and headache acted as the onset of illness in six cases. Eight cases were treated with ART, and 4 cases were on chemotherapy. Four cases did not follow-up, and 7 died recently. Conclusions Lymphoma should be considered in any HIV-infected patients presented with unexplainable adenopathy, fever or gastrointestinal bleeding. Biopsy should be carried out if necessary to confirm diagnosis. Appropriate chemotherapy, together with ART, and the time to treatment may need more data to be further discussed.