中国汉族人艾滋病相关型卡波西肉瘤23例临床和治疗分析

Clinical Characteristics and Therapy of 23 Patients with AIDS-related Kaposi's Sarcoma in Chinese Han People

目的:分析23例艾滋病相关型卡波西肉瘤(AIDS-KS)患者的临床特征及其治疗反应。方法:对2003~2015年我院诊治的23例AIDS-KS患者的资料进行回顾性分析。结果:23例患者中,男22例,女1例,平均年龄(34.9±9.2)岁。其中43.48%(10/23)的患者以皮疹为主诉,但入院查体发现78.26%(18/23)的患者均可见皮疹。22.22%(4/18)的患者皮损局限,表现为紫罗兰色结节或肿块,77.78%(14/18)的患者皮损泛发,表现为紫色丘疹、结节或斑块,皮疹长轴与皮纹或皮肤张力线方向平行。实验室检查:93.75%(15/16)的患者CD4^+T细胞数量下降。组织病理均可见梭形细胞形成的裂隙状血管,其内可见红细胞,免疫组化人类疱疹病毒8型(HHV8)阳性率为95.65%(22/23)。全部患者均予高效抗逆转录病毒治疗(HAART),部分患者辅以物理治疗。随访1年,78.26%(18/23)的患者病情好转。结论:AIDS-KS好发于中青年男性,典型皮疹表现为紫色丘疹、结节及斑块,但确诊仍依赖组织病理,HHV8免疫组化通常阳性。经HAART治疗后,病情大多好转。

Objective：To analyze the clinical characteristics and therapy of 23 patients with AIDS-related Kaposig sarcoma. Methods： From 2003 to 2015, 23 patients with AIDS-related Ka- posi＇s sarcoma admission to the Guangzhou the 8th Peopleg Hospital were obtained. Results：The patients showed a male/female ratio of 22：1 with an average age of 34.9 ± 9.2 years. And 43.48% （10/23） patients took rashes as chief complaint, but the body check found that 78.26% （18/23） patients showed visible rashes. The lesions in 22.22% （4/18） patients were localized and characterized by violet nodules or masses, while the lesions in 77.78% （14/18） patients were disseminated and characterized by a lot of purple papules, nodules or plaques along the der- matoglyph. Laboratory examination showed that the CD4＋T cell count in 93.75% （15/16） pa- tients were declined. The most typical feature of Kaposig sarcoma is the presence of spindle cells forming slits containing red blood cells, which were seen in all patients. Human herpesvirus 8 （ HHV8 ） were present in 95.65% （ 22/23 ） patients. Highly active antiretroviral therapy （HAART） were started in all patients, some patients also supplemented by physical or chemical treatment, after 1 year, 78.26% （ 18/23 ） patients got better. Conclusion： AIDS-KS occurred more in young and middle-aged men with typical clinical manifestations-purple papules, nodules or plaques, but definite diagnosis can be made only by biopsy and microscopic examination and the immunohistochemistry of HHV8 was always positive. Treating the cause of the immune system dys- function with HAART can slow or stop the progression of KS.