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目的分析比较人类免疫缺陷病毒(HIV)阳性与阴性弥漫大B细胞淋巴瘤患者的临床特点及疗效。方法收集博茨瓦纳弗朗西斯敦市仰加奎医院肿瘤内科2012年3月至2015年3月诊治的弥漫大B细胞淋巴瘤患者共71例,其中HIV阳性37例,HIV阴性34例,给予CHOP方案一线化疗,对两组的临床特点及疗效进行分析。结果与HIV阴性组相比,HIV阳性组B症状发生率高(56.8%vs.29.4%;P=0.020),更容易出现胃肠道(37.8%vs.14.7%;P=0.028)、肝(29.7%vs.9.7%;P=0.027)、肺(27.0%vs.9.7%;P=0.048)浸润。HIV阳性组与HIV阴性组治疗完全缓解率分别为18.9%(7/37)与41.2%(14/34)(P=0.040);客观有效率分别为48.6%(18/37)与70.6%(24/34)(P=0.060)。HIV阳性组化疗后出现贫血、白细胞下降及继发感染比例高于HIV阴性组(均P<0.05)。HIV阳性组中有24例在确诊淋巴瘤前已给予高效价抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)治疗,13例确诊后给予HARRT治疗,其客观有效率分别为41.7%和61.5%(P=0.248)。CD4+细胞数>200/mm3和≤200/mm3患者,其客观有效率分别为71.4%和34.8%(P=0.031)。结论 HIV阳性患者就诊时表现出更强的侵袭性。结合HARRT治疗,CHOP方案可使HIV阳性患者达到类似于HIV阴性患者的客观有效率,但完全缓解率低。HIV阳性组患者HARRT起始治疗时间不影响近期疗效。CD4~+细胞数低是近期疗效不良的预测因素。
Objective To analyze and compare the clinical features and therapeutic effects of human immunodeficiency virus (HIV) positive and negative diffuse large B cell lymphoma patients. Methods A total of 71 patients with diffuse large B-cell lymphoma who were diagnosed and treated from March 2012 to March 2015 in Yangkkui Hospital, Francistown, Botswana were enrolled. Among them, 37 were HIV-positive and 34 were HIV-negative and were given CHOP regimen as first-line chemotherapy , The clinical features and efficacy of the two groups were analyzed. Results Compared with HIV-negative group, the incidence of symptoms of B in HIV-positive group was higher (56.8% vs.29.4%; P = 0.020), more likely to occur in the gastrointestinal tract (37.8% vs.14.7%; P = 0.028) 29.7% vs.9.7%; P = 0.027), lung (27.0% vs.9.7%; P = 0.048) infiltration. The complete remission rates of HIV-positive and HIV-negative patients were 18.9% (7/37) and 41.2% (14/34), respectively (P = 0.040). The objective response rates were 48.6% (18/37) and 70.6% 24/34) (P = 0.060). Anemia, leukopenia and secondary infection were higher in HIV-positive group than in HIV-negative group (all P <0.05). Twenty-four of the HIV-positive patients were treated with highly active antiretroviral therapy (HAART) before the diagnosis of lymphoma, and 13 patients were diagnosed with HARRT after treatment. The objective response rates were 41.7% and 61.5% (P = 0.248). The objective effective rates for CD4 + cell count> 200 / mm3 and ≤200 / mm3 were 71.4% and 34.8%, respectively (P = 0.031). Conclusion HIV positive patients showed more aggressive behavior at the time of diagnosis. In combination with HARRT, the CHOP regimen provides an objective response to HIV-positive patients similar to HIV-negative patients, but with a low complete remission rate. The onset of HARRT in HIV-positive patients did not affect the short-term response. Low CD4 ~ + cells are predictors of poor outcome in the near future.