艾滋病相关非霍奇金淋巴瘤7例临床分析并文献复习

Seven cases report of AIDS related non-Hodgkin lymphoma and literature review

目的探讨艾滋病相关非霍奇金淋巴瘤患者的临床特点。方法回顾性分析7例艾滋病相关非霍奇金淋巴瘤患者的流行病学资料、临床特点、病理结果、治疗及预后，并总结相关文献。结果7例艾滋病相关非霍奇金淋巴瘤患者均为男性，年龄31—57岁，均为男男同性性行为者。4例患者在确诊艾滋病后8—24个月内出现淋巴瘤相关症状，3例患者在淋巴瘤诊治过程中发现HIV感染。原发部位分别为颌下淋巴结、胃部、牙龈、腹股沟淋巴结和腋窝淋巴结。4例有结外受累，以胃肠道为主。7例患者合并症少且未合并其他机会感染，均未出现神经系统受累。就诊时均未行抗逆转录病毒治疗，CD4＋T细胞数192～492／μl，平均321个／μl。HIV病毒载量1×10^4～3．5×10^3拷贝／ml。7例病理类型均为B细胞淋巴瘤，其中5例弥漫大B细胞淋巴瘤，1例浆母细胞淋巴瘤，1例BurKitt淋巴瘤。除1例放弃治疗外，6例患者同时接受淋巴瘤化疗和抗反转录病毒治疗，其中1例同时进行自体干细胞移植。经过6个周期的化疗，3例完全缓解，3例部分缓解。化疗后均未出现严重不良反应。经过抗逆转录病毒治疗后，患者的HIV病毒载量均未测出，CD4＋T细胞数明显上升。结论早期抗逆转录病毒治疗能减少艾滋病相关淋巴瘤的发生，并改善预后。

Objective To investigate the clinical features and the treatment of the patients with AIDS related non- Hodgkin lymphoma （ARL）. Methods The epidemiology, clinical data, pathology, treatment and prognosis of ARL were retrospectively analyzed, and relative literatures were reviewed. Results Seven ARL patients were male. Lymphoma relat- ed symptoms occurred in 4 patients after 8-24 months who were diagnosed AIDS, 3 patients were found to have HIV infec- tion during the diagnosis and treatment process of lymphoma. Primary sites included submandibular lymph nodes, stom- ach, gingiva, inguinal lymph nodes, and axillary lymph nodes. Four patients had extranodal involvement, mainly in the gastrointestinal tract. Seven patients had few complications and didn＇t have opportunistic infections and nervous system in- volvement. When diagnosed, the average count of CD4＋ T cell was 321/μl, HIV viral load was（ 1 × 10^4-3.5× 10^5） copies/ml. None were treated with antiretrovirus therapy （ART）. All the pathological types were B cell-originated, including diffuse large B-cell lymphoma, plasmablastic lymphoma, BurKitt lymphoma. One patient gave up treatment, the other 6 patients were treated with ART and chemotherapy, 1 case received autologous stem cell transplant among them. After 6 cycles of chemotherapy, 3 cases achieved complete remission, 3 achieved partly remission. There were no serious adverse effects of chemotherapy. HIV was not detected and CD4＋ T cell counts increased significantly after ART. Conclusion Early ART can reduce the incidence of ARL, and improve the prognosis.