艾滋病相关恶性淋巴瘤的临床特征及转归

Clinical characteristics and prognosis of patients with acquired immune deficiency syndrome related lymphoma

目的分析艾滋病相关恶性淋巴瘤（ARL）的临床特点、病理特征以及预后影响因素。方法回顾性分析53例ARL患者的临床特征、治疗经过和生存状态，按1∶2随机抽取与ARL人口统计学及临床特征相匹配的106例普通非霍奇金淋巴瘤（NHL）患者，比较ARL与NHL患者的临床特征、治疗经过和生存状态。进一步分析ARL患者生存的影响因素。统计学处理采用χ^2检验，单因素分析采用Kaplan-Meier法，多因素分析采用Cox回归模型。结果ARL的主要病理类型是弥漫大B细胞淋巴瘤，占60.4%（32/53）；B淋巴细胞来源淋巴瘤占88.7%（47/53），T淋巴细胞来源淋巴瘤占11.3%（6/53）。ARL患者接受放射和化学治疗的比例为62.3%（33/53），低于普通NHL患者的94.3%（100/106），差异有统计学意义（χ^2＝26.58，P〈0.05）；ARL患者HBsAg阳性率为1.9%（1/53），低于普通NHL患者的26.4%（28/106），差异有统计学意义（χ^2＝14.26，P〈0.05）；其他临床特征两组间差异均无统计学意义。ARL和普通NHL患者的生存时间分别为（6.0±1.3）个月和（48.0±10.0）个月（t＝8.13，P〈0.01）。ARL患者1、2、3和5年生存率分别为39.6%、32.7%、27.7%和20.1%，普通NHL患者分别为79.2%、56.8%、42.4%和25.0%。33例ARL患者与100例普通NHL患者接受抗NHL治疗后，1年生存率分别为60.6%和83.0%（χ^2＝4.040，P＝0.043），2年生存率分别为53.5%和60.5%（χ^2＝0.003，P＝0.096），3年生存率分别为48.1%和45.9%（χ^2＝0.288，P＝0.59），5年生存率分别为39.1%和27.5%（χ^2＝0.798，P＝0.372）。是否接受NHL治疗和国际预后指数是ARL患者生存的影响因素（均P〈0.05）。结论ARL的主要病理类型是弥漫大B细胞淋巴瘤，ARL患者的生存期明显短于普通NHL患者，抗病毒和抗肿瘤联合治疗能延长ARL患者的生存时间。

Objective To explore the clinical characteristics, pathological features and prognostic factors of patients with acquired immune deficiency syndrome （AIDS） related lymphoma （ARL）. Methods The clinical characteristics, treatment regimen and survival status were retrospectively analyzed. At a ratio of 1：2, 106 general non-Hodgkin lymphoma （NHL） cases were included after matching for demography and clinical characteristics with 53 ARL patients. Chi-square test was used for statistical analysis. Overall survival was analyzed using Kaplan-Meier curves. Cox regression was used for multivariant analysis. Results The predominant pathologic type of ARL was diffuse large B cell lymphoma （60. 4%, 32/53）. B cell lymphoma accounted for 88. 7% （47/53） and T cell lymphoma accounted for 11.3% （6/53）. Patients in ARL group （62.3%, 33/63） had lower proportion of receiving radiotherapy or chemotherapy compared with patients in general NHL group （94. 3 %, 100/106） （χ^2=26.58, P（0.05）. ARL group had lower hepatitis B surface antigen （HBsAg）positivity rate compared with general NHL group （1.9% vs 26.4%, χ^2 = 14.26, P〈0.05）. No other characteristic was found significantly different between these two groups. The survival time of ARL and general NHL patients was （6.0±1. 3） months and （48.0±10.0） months, respectively （t=8.13, P〈0.01）. The 1- year, 2-year, 3-year and 5-year survival rates of ARL patients were 39.6%, 32.7%, 27.7% and 20.1%, respectively,while those of general NHL patients were 79.2%, 56.8%, 42.4% and 25.0^, respectively. Of the 33 ARL patients and 100 general NHL patients who received anti-NHL treatment, the 1-year survival rates were 60.6% and 83.0%, respectively （χ^2=4. 040, P=0. 043）, the 2-year survival rates were 53.5% and 60.5%, respectively （χ^2=0. 003, P=0. 096）, the 3-year survival rates were 48.1% and 45.9%, respectively （χ^2=0. 288, P=0.59）, the 5-year survival rates were 39.1% and 27.5%, respectively （χ^2 =0. 798, P=0. 372）. Multivariate analysis revealed that anti-NHL therapy and international prognostic index score were independent predictors for prognosis （both P〈0.05）. Conclusions Di{fuse large B cell lymphoma is the predominant pathologic type o{ ARL. ARL patients has significantly lower survival rate compared with general NHL patients. Combination of anti-HIV therapy and anti-lymphoma therapy in individuals with ARL can prolong their survival time.