艾滋病合并伯基特淋巴瘤5例临床分析及文献复习

Five case reports of AIDS-related Burkitt lymphoma and literature review

目的探讨艾滋病合并伯基特淋巴瘤(Burkitt lymphoma, BL)患者的临床特征。方法回顾性分析首都医科大学附属北京佑安医院感染中心2010-2017年住院的5例艾滋病合并BL患者的临床特征、实验室检查、治疗转归并总结相关文献。结果 5例患者均为男性,年龄22～48岁。3例在确诊BL前发现HIV-1感染,2例确诊BL过程中发现HIV-1感染。5例均以局部肿物为首发症状,原发部位分别为鼻咽部、枕部、腋下、腹股沟,3例患者合并中枢神经系统侵犯。5例患者淋巴瘤国际预后指数评分(international prognostic index, IPI)≥3分,4例Ann Anbor分期为Ⅲ～Ⅳ期。就诊时3例患者接受短期联合抗反转录病毒治疗(combine anti-retroviral therapy, cART),2例未行cART。5例患者CD4+T细胞94～500个/μl,平均(271.4±145.5)个/ul。1例化疗后病情进展死亡,1例放弃化疗自动出院,余3例同时接受化疗和cART,3例化疗后出现严重的骨髓抑制,且1例化疗后出现消化道出血,1例化疗后出现消化道真菌感染。5例患者均死亡。结论艾滋病合并BL病情进展迅速,早期诊治有助于改善预后。

Objective To investigate the clinical features of patients with AIDS complicated with Burkitt lymphoma. Methods The data of 5 AIDS patients with Burkitt lymphoma were analyzed by the epidemiology, clinical data, imaging, laboratory examination, treatment and prognosis from Center for Infectious Diseases of Beijing You’an Hospital from 2010 to 2017, and relative literatures were reviewed. Results Five male patients aged 22 to 48 years old were included in this retrospective study. Among them, 3 patients were diagnosed HIV infection before Burkitt lymphoma, and 2 patients were diagnosed HIV-1-infected during diagnosis of Burkitt lymphoma. Five patients with local mass as the first symptoms. Primary sites included nasopharyngeal lesions, occipital neoplasm, axillary mass, inguinal mass, 3 patients had central nervous system involvement. Five patients’ IPI score≥3 and 4 patients with Ann Anbor stage Ⅲ～Ⅳ. Three patients were treated with antiretroviral therapy in short time and 2 patients had none. The count of CD4＋T cell was 94～500/μl in 5 patients, the median count was（271.4±145.5）/μl. Severe bone marrow inhibition occurred after chemotherapy in 3 cases. And gastrointestinal hemorrhage occurred after chemotherapy in 1 case. One case occurred gastrointestinal fungal infection after chemotherapy. One patient died of disease progression after chemotherapy, 1 patient abandoned chemotherapy and left the hospital automatically. The other 3 patients received chemotherapy and antiviral treatment at the same time, and all the 5 patients died. Conclusion AIDS complicated with Burkitt lymphoma is progressing rapidly, and early diagnosis and treatment can improve the prognosis.