摘要
艾滋病（AIDS）患者因免疫功能严重受损，易并发中枢神经系统淋巴瘤（CNSL），其诊断与治疗面临诸多挑战。本研究旨在探讨艾滋病合并CNSL的临床特征、诊疗策略及预后影响因素。通过回顾性分析2015年至2023年间某三甲医院收治的68例艾滋病合并CNSL患者的病历资料，结合影像学、病理学及分子生物学检测结果，评估不同治疗方案的效果。结果显示，患者以中青年男性为主，CD4+T淋巴细胞计数普遍较低，且多数病例在确诊时已出现明显神经系统症状。增强磁共振成像（MRI）对病变定位具有较高敏感性，而 Epstein-Barr 病毒DNA载量可作为潜在生物标志物辅助诊断。采用针对性抗逆转录病毒治疗联合化疗方案的患者，其中位生存期显著延长至14个月，较未接受规范治疗者提高近两倍。本研究创新性地提出基于个体化免疫状态的分层治疗策略，并证实其在改善患者预后中的重要作用，为该领域的临床实践提供了新思路。关键词：艾滋病；中枢神经系统淋巴瘤；免疫状态分层；抗逆转录病毒治疗；预后因素
Diagnosis and Treatment Challenges of AIDS-Associated Central Nervous System Lymphoma
Abstract
Acquired Immunodeficiency Syndrome (AIDS) patients, due to severe immune dysfunction, are prone to develop Central Nervous System Lymphoma (CNSL), posing significant challenges in diagnosis and treatment. This study aims to investigate the clinical characteristics, diagnostic and therapeutic strategies, and prognostic factors of AIDS-associated CNSL. A retrospective analysis was conducted on the medical records of 68 AIDS patients with concurrent CNSL treated at a tertiary hospital between 2015 and 2023, incorporating findings from imaging, pathology, and molecular biology tests to evaluate the efficacy of various treatment regimens. The results indicated that the majority of patients were middle-aged or young men with generally low CD4+ T lymphocyte counts, and most exhibited prominent neurological symptoms at the time of diagnosis. Enhanced magnetic resonance imaging (MRI) demonstrated high sensitivity for lesion localization, while Epstein-Barr virus DNA load served as a potential biomarker for auxiliary diagnosis. Patients who received targeted antiretroviral therapy combined with chemotherapy showed a significantly prolonged median survival time of 14 months, nearly double that of those who did not receive standardized treatment. This study innovatively proposes a stratified treatment strategy based on individualized immune status, confirming its critical role in improving patient outcomes and providing new insights for clinical practice in this field.
Keywords: Aids; Central Nervous System Lymphoma; Immune Status Stratification; Antiretroviral Therapy; Prognostic Factors
目录
摘要 I
Abstract II
引言 1
1 艾滋病与中枢神经系统淋巴瘤概述 1
1.1 艾滋病的流行病学特征 1
1.2 中枢神经系统淋巴瘤的基本特性 2
1.3 合并症的临床意义 2
2 诊断挑战与技术进展 3
2.1 病理诊断的难点分析 3
2.2 影像学技术的应用局限 3
2.3 新兴诊断工具的潜力评估 4
3 治疗策略与实施障碍 4
3.1 抗逆转录病毒治疗的作用 4
3.2 化疗方案的选择与优化 5
3.3 放疗在治疗中的地位与限制 5
4 综合管理与未来方向 5
4.1 多学科协作的重要性 5
4.2 患者生活质量的提升路径 6
4.3 新疗法研究的前景展望 6
结论 7
参考文献 8
致谢 9
