Acquired immunodeficiency syndrome-associated lymphoma

Introduction to Acquired Immunodeficiency Syndrome Related Lymphoma Acquired immunodeficiency syndrome-associated lymphoma mainly occurs in patients with advanced AIDS, and the peripheral blood CD4 cells are often less than 100/L. Therefore, the occurrence of lymphoma is mainly related to the severity and long duration of cellular immune function defects. AIDS-associated lymphoma is more common in Caucasians than in blacks, suggesting that its onset is related to genetic factors. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific population Mode of transmission: sexual transmission, blood transmission, mother-to-child transmission Complications: gastrointestinal bleeding

Acquired immunodeficiency syndrome-associated lymphoma etiology

Cause:

Many data suggest that immunosuppression and EBV infection tend to proliferate B cell clones that are undergoing oncogene or tumor suppressor gene alterations. In immunoblastic lymphoma, these genes include c-MYC and TCL1 oncogenes. Consistently, there is data showing that in patients with AIDS-related lymphoma, a B-cell stimulating factor and serum soluble CD23 levels are significantly elevated in patients with AIDS-associated lymphoma, suggesting that chronic B-cell stimulation is induced. Important factors of lymphoid tumors, in addition, HIV can infect endothelial cells to increase the adhesion between tumor lymphocytes and endothelial cells, so that tumor cells are in close contact with growth factors produced by endothelial cells and accelerate the spread of tumor cells to tissues. It is another important factor in the occurrence, development and dissemination of AIDS-related lymphoma.

Pathogenesis

Genetic changes not only play an important role in the pathogenesis of AIDS-associated lymphoma, but also determine the histological type of final clonal proliferation. All AIDS-related Burkitt lymphomas or Burkitt-like lymphomas have chromosomal translocations, making c - The MYC gene is close to the immunoglobulin gene locus, and the c-MYC proto-oncogene is out of regulation. In this disease, more than 60% of cases are accompanied by p53 mutation leading to uncontrolled apoptosis, and more than 70% of various tissues In the type of AIDS-associated lymphoma, there is a mutation that causes the BCL-6 proto-oncogene to be out of control. Under normal physiology, the expression of BCL-6 is limited to the germinal center (GC) cells, and its expression is necessary for the formation of GC. Under normal conditions, after GC formation, the GC cells stop expressing the product of the BCL-6 gene and continue to express the CD138 antigen (syndecan-1) to differentiate into plasma cells.

Acquired immunodeficiency syndrome-associated lymphoma prevention

1. Avoid sexual contact with human immunodeficiency virus

Anal or vaginal intercourse can cause damage to the rectum or vaginal mucosa. Human immunodeficiency virus in semen and vaginal secretions can be transmitted to the other side through the damaged mucous membrane into the blood circulation. Strengthen health education on sexual knowledge and sexual behavior related to HIV and AIDS, and protect yourself from sexual contact with HIV-infected people. Resolutely ban and severely crack down on ugly acts such as prostitution and prostitution.

2. Prevent the spread of the injection route

Drug abuse is strictly prohibited, especially for injecting drugs. Strengthen drug abuse and drug rehabilitation, strengthen poison education, and eliminate poison. Do not share needles, syringes and drugs, use disposable syringes and acupuncture needles. Prevent stab wounds from needles or instruments contaminated with HIV.

3. Strengthen blood product management

Strengthen the management of the blood products market. All blood products such as blood and plasma should be collected, tested and supplied by blood stations with relevant qualifications. It is strictly forbidden to illegally collect and supply blood. The relevant state law enforcement agencies should resolutely ban underground blood stations and crack down on underground blood heads and blood tyrants. Strict physical examinations are performed on blood donors, including HIV antibody testing. High-risk groups should ban the donation of whole blood, plasma, organs, tissues or semen. It is strictly forbidden to import all kinds of blood products from abroad, including whole blood, plasma, human albumin, gamma globulin, various blood components.

4. Cut off mother-to-child transmission HIV-infected persons, especially those infected with HIV-1, should try to avoid pregnancy to prevent mother-to-child transmission. Since HIV can be transmitted to infants through breastfeeding, HIV-infected lactating women should not be breastfed and replaced with artificial feeding.

5. Strengthen disinfection and isolation measures For articles or instruments contaminated by blood or body fluids, effective disinfectant drugs can be used, such as freshly prepared 500×10-65000×10-6 (1:101:100 dilution) concentration. Wipe or soak with sodium hypochlorite or a 1:10 diluted chlorine-containing lime solution. The waste products used by the patient should be disinfected before being otherwise treated or incinerated. Avoid direct contact with the patient's blood or body fluids. Wear gloves and gowns. In case of accidental contamination by blood or body fluids, it should be thoroughly cleaned and disinfected immediately.

6. Strengthening the missionary work to enable the general public to have a correct understanding of acquired immunodeficiency syndrome. Pay attention to personal hygiene and do not share items such as toothbrushes, shaving blades, utensils, basins and towels.

7. Strengthen business training For epidemic prevention and medical institutions, personnel should be trained in relevant business knowledge, improve business level, standardize diagnosis and treatment, including the promotion of international standard treatment programs, and develop treatment guidance programs suitable for rural areas in China.

8. HIV vaccine research to produce an effective HIV vaccine may be the hope of eradicating acquired immunodeficiency syndrome. However, due to the high mutation rate of HIV gene, integration of human host cells by viral genes, and direct invasion of the host's immune system by viruses, the development of HIV vaccines has greatly increased. Although a lot of manpower and material resources have been invested at home and abroad, long-term research and various vaccine research, such as inactivated vaccine, attenuated vaccine, subunit vaccine, nucleic acid vaccine, neutralizing antibody vaccine, etc., have not been successful. The vaccine is available. At present, some mature vaccines abroad are undergoing preclinical or clinical trials, but most of them are subtype B HIV strains. However, China's popular A, B, B' subtypes, C, E five types, so whether the vaccine developed abroad can be applied to China, is still unknown. Therefore, it is extremely important to develop HIV vaccines based on popular strains in China. However, from the current situation in China, there is still a long way to go.

9. Strengthen monitoring of acquired immunodeficiency syndrome

Because the economic and cultural developments in various parts of China are extremely unbalanced; most people, including a considerable number of medical personnel, lack understanding of acquired immunodeficiency syndrome knowledge; people's sexual attitudes change, casually cohabitation, multiple sexual partners; prostitution, prostitution and other ugly phenomena Flooding; the gradual spread of drug trafficking; the extremely weak medical conditions at the primary level; and the uneven monitoring of medical, health and epidemic prevention agencies at all levels, etc., have caused the spread of acquired immunodeficiency syndrome in China, HIV in China The infection rate and the incidence of acquired immunodeficiency syndrome have entered a period of rapid growth, and China's population base is huge, and its development trend is likely to have a negative impact on social politics and economic life. Therefore, it is necessary to strengthen the monitoring of acquired immunodeficiency syndrome in China and improve the monitoring network so that the state can accurately grasp the changes of the epidemic situation. It is very important for the state to formulate corresponding laws and regulations and take timely and effective prevention and control measures.

(1) Implement and strengthen the epidemic reporting system: especially the epidemic situation report of primary health care institutions should be implemented.

(2) Strengthening the monitoring of high-risk groups: China's current key monitoring targets include: 1 those who have applied foreign blood products; 2 those who have had sexual relations with foreigners; 3 Chinese students studying abroad, laborers, Long-term foreigners and visitors; 4 foreign foreigners in China, tourists from China, international students, diplomats, etc.; 5 prostitutes, deaf and drug users; 6 with HIV-infected patients and patients with acquired immunodeficiency syndrome People who have been in close contact.

(3) Strengthening border quarantine: prohibiting entry of HIV-infected persons and patients with acquired immunodeficiency syndrome.

Acquired immunodeficiency syndrome-associated lymphoma complications Complications, gastrointestinal bleeding

Fatal complications such as gastrointestinal bleeding, perforation and obstruction can occur in 40% of patients.

Acquired immunodeficiency syndrome-associated lymphoma symptoms Common symptoms HIV infection High fever Unexplained fever Facial pain Immunodeficiency biliary obstruction Lymph node enlargement Paralysis visceral obstruction

The clinical manifestations of systemic NHL in HIV-infected patients are diverse but not characteristic. Most of them have B symptoms at the time of onset. At least 80% of patients have stage IV onset, usually with little involvement of lymph nodes and extranodal involvement. This is in stark contrast to the clinical manifestations of patients with the same type of lymphoma who are not infected with HIV.

Visceral obstruction or hemorrhage, unexplained fever for more than 2 weeks is often the manifestation of HIV complicated with lymphoma. The gastrointestinal tract is the most common extranodal lesion of AIDS-related systemic lymphoma. The main symptoms are abdominal pain or (and) body weight. Relieve, the incidence of liver, lung and bone marrow involvement in systemic lymphoma patients accounts for about 1/3, liver involvement can be clinically asymptomatic or biliary obstruction-like pain.

Systemic lymphoma invades the CNS, typically 3% to 20% of patients with lymphocytic meningitis. The pia mater lesions are often difficult to detect during physical examination. Nearly 1/4 of the patients are asymptomatic, even if there are only a few symptoms. There are meningeal signs, other symptoms of pia mater involvement include headache and cranial nerve palsy, and lymphoma meningitis often recurs, especially in patients who have not received intrathecal prophylactic treatment at the start of treatment.

Examination of acquired immunodeficiency syndrome-associated lymphoma

Pathological examination

Biopsy of the suspicious part of the tissue is the main method to diagnose the disease, the diagnosis rate is 75% to 100%, fine needle aspiration (FNA) swollen lymph node tissue pathological examination is also diagnostic for lymphoma, but only positive results Diagnosis is helpful, and negative results cannot rule out lymphoma diagnosis. For example, bone marrow biopsy, lung biopsy, and bone marrow biopsy are both useful and safe diagnostic tools.

2. Bone marrow infiltration is common in small, non-cracked (Burkitt-like) lymphoma, and bone marrow infiltration more than 50% of bone marrow volume suggests poor prognosis.

3. Biochemical examination

Changes in transaminase, urea nitrogen and electrolytes may occur in liver function damage.

Most lung lesions require a lung biopsy to confirm the diagnosis. The diagnostic rates of transbronchial and open chest biopsy are reported to be 58% and 75%, respectively, and the diagnosis rate of thoracoscopic needle aspiration biopsy is 50%.

4. CT examination

Chest CT showed pleural effusion, lung consolidation, interstitial infiltration, block shadow and hilar mediastinum, lymphadenopathy, liver and spleen involvement mostly as low-density mass shadows, manifested as multiple isolated lesions surrounding the intestinal wall, Intestinal wall thickening or focal cavity-like lesions.

5. X-ray inspection

The detection rate is greater than 95%. Typical lesions include pleural effusion, consolidation of the lung lobes, interstitial infiltration, block shadow, and hilar and mediastinal lymph nodes.

6. Radionuclide imaging examination

In AIDS patients, there is a delay in the absorption of gallium or other nuclides.

7. Thoracentesis

The pleural effusion is exudate, and the concentration of LDH is often very high. The diagnostic sensitivity of pleural effusion cytology combined with pleural biopsy is about 75%.

8. Lumbar puncture

Because AIDS-related systemic lymphoma involves the occurrence of CNS, some scholars believe that lumbar puncture should be routinely performed for suspicious patients for timely intrathecal treatment. When CSF cytology and routine biochemical tests are negative, CSF EBV - DNA assay will help diagnose.

Diagnosis and differentiation of acquired immunodeficiency syndrome-associated lymphoma

AIDS patients with long-term unexplained hyperthermia, superficial lymphadenopathy, imaging abnormalities are the clues to diagnose this disease, the final diagnosis requires biopsy in the suspected affected area, bone wear, chest wear and lumbar puncture can help staging, It also plays an important role in the diagnosis of this disease.

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