艾滋病相关淋巴瘤84例临床特征和预后分析

Clinical characteristics and prognosis of AIDS related lymphoma:An analysis of 84 cases

目的探究艾滋病相关淋巴瘤(Acquired immunodeficiency syndrome-related lymphpma,ARL)患者临床特征及预后的影响因素。方法回顾性分析2013年3月至2021年10月浙江大学医学院附属第一医院84例ARL患者的临床资料,采用多因素Cox回归模型评估ARL患者预后的影响因素。结果84例ARL患者中,非霍奇金淋巴瘤占95.2%(80/84)。52.3%(44/84)患者伴随发热、盗汗及体质量减轻等淋巴瘤B症状。根据Ann Arbor分期,Ⅲ~Ⅳ期占84.5%(71/84)。58.0%(47/81)患者基线CD4+T淋巴细胞计数≤200个/μL。接受放化疗期间,发生肺部感染30例(35.7%),消化道感染11例(13.1%),21.4%(18/84)患者发生败血症。84例患者1年生存率是70.2%(59/84)。通过多因素Cox分析显示,国际预后指数(International prognostic index,IPI)评分>3分(HR=5.094,95%CI 1.877~13.824,P=0.001)是ARL患者预后的独立危险因素,接受利妥昔单抗治疗(HR=0.354,95%CI 0.152~0.823,P=0.016)是ARL患者预后的独立保护因素。结论ARL临床表现多样化,确诊时常处于疾病晚期,并发症多,预后不佳。IPI评分和是否接受利妥昔单抗治疗是影响ARL患者预后的关键因素。

Objective To analyze the clinical characteristics and prognosis of patients with AIDS-related lymphoma(ARL).Methods The clinical data of 84 patients with ARL admitted in the First Affiliated Hospital Zhejiang University School of Medicine from March 2013 to October 2021 were retrospectively reviewed,and the influencing factors for prognosis of patients were analyzed by Cox proportional risk regression model.Results Non-Hodgkin’s lymphoma accounted for 95.2%(80/84)of all cases;52.3%(44/84)of the patients presented with B symptoms of lymphoma such as fever,night sweats,and weight loss,and 84.5%(71/84)of them were classified as stageⅢ~Ⅳby Ann Arbor staging;58.0%(47/81)patients had CD4+T cell count≤200/μL at baseline;30(35.7%)patients had pulmonary infection,11(13.1%)patients had digestive tract infection,and 21.4%(18/84)patients had sepsis.The 1-year survival rate of 84 patients was 70.2%(59/84).Multivariate Cox survival analysis showed that International prognostic index(IPI)score>3(HR=5.094,95%CI 1.877-13.824,P=0.001)was an independent risk factors and rituximab treatment(HR=0.354,95%CI 0.152-0.823,P=0.016)was an independent protective factor for the prognosis of patients with ARL.Conclusions The clinical manifestations of ARL are diverse,and it is often diagnosed in the late stage of the disease with adverse prognosis.IPI score and Rituximab treatment are key prognostic factors in patients with ARL.