[Clinicpathological features and survival of patients with AIDS related non-Hodgkin's lymphoma]

目的

分析艾滋病相关非霍奇金淋巴瘤（ARL）患者的临床特征及生存状态。

方法

回顾性分析53例ARL患者的临床资料，按1∶2随机配对对照研究方法，以106例普通非霍奇金淋巴瘤（NHL）患者为对照，比较两组患者的生存率。

结果

53例ARL患者的平均年龄为43（11~67）岁，诊断NHL时CD4⁺T细胞中位数为（146±20）个/µl。53例患者中B细胞来源者47例（88.7%），T细胞来源者6例（11.3%）。Ann Arbor分期Ⅲ~Ⅳ期者占52.8%（28/53）；IPI评分中高危组和高危组患者比例分别为45.3%（24/53）和18.9%（10/53）。ARL诊断后放弃治疗者占37.7%（20/53），抗HIV治疗联合放化疗者占62.3%（33/53）。抗NHL治疗采用CHOP（环磷酰胺、长春新碱、表阿霉素、泼尼松）方案。ARL组患者的总生存（OS）时间显著短于对照组[（6.0±1.3）对（48.0±10.0）个月，P<0.05]。接受抗NHL治疗的患者中，ARL组（33例）和对照组（100例）患者的OS时间差异无统计学意义[（48.0±10.9）对（77.0±11.1）个月，P=0.816]；ARL组患者1年OS率低于对照组（60.6%对83.0%，P<0.05），但两组患者的2年（53.5%对60.5%）、3年（48.1%对45.9%）和5年（39.1%对27.5%）OS率差异均无统计学意义（P值均>0.05）。

结论

ARL多见于青壮年，1年内病死率高，抗HIV治疗联合CHOP方案抗NHL治疗能显著改善ARL患者预后。

[Evaluation of prevalent status of kala-azar in endemic area of Hubei Province]

OBJECTIVE

To identify the diagnosis of 14 cases with "kala-azar" previously reported in Hubei Province since 1989 and to evaluate the present status of the disease.

METHODS

Bone marrow smear, immunological test (LDTand IFAT), mouse inoculation, fungi culture, vector (Phlebotomus) and reservoir host (dog) survey.

RESULTS

Among the 14 cases, 12 cases were progressive disseminated histoplasmois, one was an imported case and another one was a remnant skin type "kala-azar" case. An immunological survey was conducted during 1997-1999 in 25 townships located in 23 counties of 9 prefectures and cities. A total of 13,890 persons had been examined by LDT, the positive rate was 0.07%, no positive case was found among the persons under 40 years of age. During the survey, 1,756 persons had been examined by IFAT, the results were negative. No Phlebotomus chinensis had been found in the surveyed area. A total of 302 dogs were examined, no sick dog had been found.

CONCLUSION

Kala-azar has been eradicated in Hubei Province.

[The detection and significance of HBV-DNA in serum and liver of advanced schistosomiasis patients]

Hepatitis B virus deoxyribonucleic acid (HBV-DNA) and surface antigen (HBsAg) in the serum and liver specimens from 31 patients with advanced schistosomiasis were investigated. The patients have been followed up for six years. The presence of HBsAg and HBcAb in serum among patients with advanced schistosomiasis were significantly more frequent than that in the control group (P < 0.05), but the prevalence of HBV-DNA and HBeAg in the patients were not significantly different from that in the controls (P > 0.05). The positive rate of HBV-DNA and HBsAg in liver was 19.4% and 48.4% respectively, which were greater than that in serum. The presence of HBV-DNA in patients with advanced schistosomiasis was associated with high mortality and the cause of death was either hepatic failure or hepatocellular carcinoma. The results suggest that it is important to detect HBV-DNA both in surum and liver. Antiviral therapy for patients with advanced schistosomiasis who had detectable HBV-DNA may improve the prognosis.

Natural killer cell activity in renal transplant recipients receiving cyclosporine

Normal subjects (n = 11) had a mean circulating natural killer (NK) cell activity of 188 lytic units per 10(7) peripheral mononuclear blood leukocytes. This activity was significantly enhanced by in vitro incubation with 500 U of alpha-interferon (+207 lytic units). The mean NK activity of renal transplant recipients on azathioprine (n = 17) or on cyclosporine (n = 17) studied at various times after transplantation was significantly decreased, as was the ability of interferon to enhance NK activity. In the cyclosporine group, interferon could not enhance NK titers 1 to 6 weeks after transplantation when the patients were on the highest doses of cyclosporine (mean, 1,002 mg/day) or when they were viremic for cytomegalovirus. After 18 weeks, when the patients received 546 mg/day or when viremia was no longer detected, the ability of interferon to enhance NK activity was more normal. Cyclosporine and cytomegalovirus infection may have a greater effect on the action of interferon on NK activity than on the NK titer per se. This defect may diminish the reserve of NK cells and contribute to post-transplant immunosuppression.

Lymphocyte subsets and natural killer cell responses during cytomegalovirus mononucleosis

Cell-mediated immunity in seven patients with cytomegalovirus mononucleosis was assessed by monoclonal antibody to lymphocyte subsets, lymphocyte blastogenesis, and natural killer cell activity. The patients had decreased ratios of helper (Leu 3a) to suppressor-cytotoxic (Leu 2a) T cells as compared with normal donors. Leu 2a+ T cells from the patients were uniquely sensitive to overnight culturing, which resulted in a 2.6-fold increase in the helper/suppressor cell ratio and the appearance of an unusual third Leu 1+ 2a- 3a- T cell subset. This correlated directly with enhanced blastogenesis to concanavalin A after preculture. Base-line and interferon-boosted natural killer cell responses versus K562 cell targets during cytomegalovirus mononucleosis did not differ from those of normal donors. This suggests that certain cellular immune functions are depressed during cytomegalovirus mononucleosis in correlation with the emergence of a culture-sensitive subset of suppressor T cells. In contrast, cytotoxic lymphocytes appear to function normally and may aid in the resolution of the illness.