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目的探讨艾滋病相关非霍奇金淋巴瘤患者的临床特点。方法回顾性分析7例艾滋病相关非霍奇金淋巴瘤患者的流行病学资料、临床特点、病理结果、治疗及预后,并总结相关文献。结果 7例艾滋病相关非霍奇金淋巴瘤患者均为男性,年龄31~57岁,均为男男同性性行为者。4例患者在确诊艾滋病后8~24个月内出现淋巴瘤相关症状,3例患者在淋巴瘤诊治过程中发现HIV感染。原发部位分别为颌下淋巴结、胃部、牙龈、腹股沟淋巴结和腋窝淋巴结。4例有结外受累,以胃肠道为主。7例患者合并症少且未合并其他机会感染,均未出现神经系统受累。就诊时均未行抗逆转录病毒治疗,CD4+T细胞数192~492/μl,平均321个/μl。HIV病毒载量1×104~3.5×105拷贝/ml。7例病理类型均为B细胞淋巴瘤,其中5例弥漫大B细胞淋巴瘤,1例浆母细胞淋巴瘤,1例Bur Kitt淋巴瘤。除1例放弃治疗外,6例患者同时接受淋巴瘤化疗和抗反转录病毒治疗,其中1例同时进行自体干细胞移植。经过6个周期的化疗,3例完全缓解,3例部分缓解。化疗后均未出现严重不良反应。经过抗逆转录病毒治疗后,患者的HIV病毒载量均未测出,CD4+T细胞数明显上升。结论早期抗逆转录病毒治疗能减少艾滋病相关淋巴瘤的发生,并改善预后。
Objective To investigate the clinical features of AIDS-related non-Hodgkin’s lymphoma. Methods The epidemiological data, clinical features, pathological findings, treatment and prognosis of 7 patients with AIDS-related non-Hodgkin’s lymphoma were analyzed retrospectively. The related literatures were summarized. Results All the 7 AIDS-related non-Hodgkin’s lymphoma patients were male, ranging in age from 31 to 57 years old, all of whom were MSM. Four patients developed lymphoma-related symptoms within 8-24 months after diagnosis of AIDS, and three patients were found to have HIV infection during diagnosis and treatment of lymphoma. Primary sites were submandibular lymph nodes, stomach, gums, inguinal lymph nodes and axillary lymph nodes. 4 cases had extranodal involvement, mainly in the gastrointestinal tract. Seven patients had fewer comorbidities and did not have other opportunistic infections, and no neurological involvement occurred. No antiretroviral treatment was given at the time of treatment. The number of CD4 + T cells was 192-492 / μl with an average of 321 cells / μl. HIV viral load 1 × 104 ~ 3.5 × 105 copies / ml. Seven cases of pathological type were B cell lymphoma, including 5 cases of diffuse large B cell lymphoma, 1 case of plasmablastic lymphoma and 1 case of Burkitt’s lymphoma. In addition to giving up treatment in 1 case, 6 patients underwent both lymphoma chemotherapy and antiretroviral therapy, including 1 case of autologous stem cell transplantation. After 6 cycles of chemotherapy, 3 patients were completely relieved and 3 patients partially relieved. No serious adverse reactions occurred after chemotherapy. After antiretroviral treatment, the patient’s HIV viral load were not detected, CD4 + T cell number increased significantly. Conclusion Early antiretroviral therapy can reduce the incidence of AIDS-related lymphoma and improve the prognosis.