头颈部获得性免疫缺陷综合征相关性卡波西肉瘤临床分析

Clinical analysis of AIDS-related Kaposi's sarcoma in head and neck

目的总结获得性免疫缺陷综合征相关性卡波西肉瘤(acquired immunodeficiency syndrome-related Kaposi's sarcoma,AIDS-KS)在头颈部的临床特点及转归。方法对2009年6月~2016年9月在北京地坛医院住院的20例头颈部AIDS-KS病例进行回顾性分析。结果 20例患者全部为男性,中位年龄(38.50±10.98)岁,满族1例,维族1例,汉族18例。同性性行为史7例,输血史2例。以头面部结节作为首诊10例,头颈部皮肤黏膜均受累,其中鼻腔黏膜受累2例。确诊时CD4^+T淋巴细胞均值为(52.55±47.87)个/mm^3。所有患者CD4+T<200个/mm^3,其中15例(75%)CD4^+T<50个/mm^3。经治后好转出院12例,因继发呼吸衰竭感染性休克等原因死亡8例。结论头颈部AIDS-KS可作为获得性免疫缺陷综合征患者就诊时的首发症状,发病时CD4^+T均<200个/mm^3。确诊后经过高效抗逆转录病毒治疗和化疗后部分好转,总体预后不佳。

OBJECTIVE To summarize the clinical features of the acquired immunodeficiency syndrome-related Kaposi＇s sarcoma（AIDS-KS） in head and neck. METHODS The clinical data of 20 inpatients with AIDS-KS in head and neck f rom Ju ne 2009 to September 2016 in Beijing Ditan Hospital were retrospectively analyzed. RESULTS All 20 patients were male, median age 38.50±10.98. One case was Manchu, 1 case was of Uygur, and others were Han nationality. There were 7 cases with homosexuality history, 2 cases with blood transfusion history, and 1 case with prostitution history. Mass in head and face was the first symptom in 10 cases. The head and neck skin and mucosa were involved, including 2 cases with nasal mucosa involvement, 4 cases with auricle skin involvement, 8 cases with oral mucosal involvement, 3 cases with facial skin involvement, 1 case with neck skin involvement, 1 case with eyelid conjunctiva involvement. Four cases had disseminated lesions. W hen diagnosed, the CD4~＋ T lymphocyte were 52.55±47.87/mm^3. The CD4~＋T were less than 200/mm^3 in all of the patients, including CD4~＋T50/mm^3 in 15 cases（75%）. After treatment with highly active antiretroviral therapy combined with or without chemotherapy, 12 cases were discharged. Eight cases died due to respiratory failure or septic shock or other reasons. CONCLUSION Kaposi＇s sarcoma of the head and neck might be the first visit of AIDS patients. Some of the patients get partial remission after highly active antiretroviral therapy and the overall prognosis is poor.