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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 354 -358. doi: 10.3877/cma.j.issn.1674-1358.2023.05.010

短篇论著

人类免疫缺陷病毒感染合并膀胱癌14例临床特点
张玉, 薛文瑞, 王鑫, 李旭瑜, 王旭东, 袁鹏飞, 梁雨润, 韩志兴, 张海建, 刘庆军, 纪世琪†()   
  1. 100015　北京，首都医科大学附属北京地坛医院泌尿外科
    100069　北京，首都医科大学附属北京佑安医院泌尿外科
  • 收稿日期:2022-12-28 出版日期:2023-10-15
  • 通信作者: 纪世琪
  • 基金资助:
    北京医学奖励基金(No. YXJL-2021-0800-0410)

Clinical features of 14 cases with bladder cancer infected with human immunodeficiency virus

Yu Zhang, Wenrui Xue, Xin Wang, Xuyu Li, Xudong Wang, Pengfei Yuan, Yurun Liang, Zhixing Han, Haijian Zhang, Qingjun Liu, Shiqi Ji†()   

  1. Department of Urology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
    Department of Urology, Beijing You’an Hospital, Capital Medical University, Beijing 100069, China
  • Received:2022-12-28 Published:2023-10-15
  • Corresponding author: Shiqi Ji
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张玉, 薛文瑞, 王鑫, 李旭瑜, 王旭东, 袁鹏飞, 梁雨润, 韩志兴, 张海建, 刘庆军, 纪世琪. 人类免疫缺陷病毒感染合并膀胱癌14例临床特点[J/OL]. 中华实验和临床感染病杂志(电子版), 2023, 17(05): 354-358.

Yu Zhang, Wenrui Xue, Xin Wang, Xuyu Li, Xudong Wang, Pengfei Yuan, Yurun Liang, Zhixing Han, Haijian Zhang, Qingjun Liu, Shiqi Ji. Clinical features of 14 cases with bladder cancer infected with human immunodeficiency virus[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(05): 354-358.

目的

探讨人类免疫缺陷病毒（HIV）感染合并膀胱癌患者的术前术后实验室指标、病理类型、治疗方法及预后，并为HIV阳性合并膀胱癌防治提供参考。

方法

收集2013年12月至2021年4月就诊于首都医科大学附属北京地坛医院和首都医科大学附属北京佑安医院的HIV感染合并膀胱癌患者14例，回顾性分析患者HIV感染途径、是否规律治疗，患者术前HIV载量与CD4+ T淋巴细胞计数，实验室指标，病理分期与分级、治疗方法，3个月复发以及远期随访。本研究数据采用描述性统计分析。

结果

入组14例患者中男性13例（93%）、女性1例（7%），平均年龄为（48.93 ± 13.83）岁；感染HIV后进行规律抗逆转录病毒治疗的患者9例，其余5例均未进行规律治疗，术前实验室检查：CD4+ T淋巴细胞：368（254，580）个/μl，白细胞：6.17（4.94，7.02）×109/L，红细胞：4.16（3.70，4.68） × 1012/L，血小板：（199 ± 60.05）× 109 /L，肌酐：70.85（65.50，75.25） μmol/L，白蛋白：41.50（39.60，44.45）g/L。入组患者皆行手术治疗，其中选择膀胱肿瘤电切治疗患者11例，进行膀胱癌根治手术者3例；其中3例患者病理为基层浸润性膀胱癌（MIBC），其余11例为非基层浸润性膀胱癌（NMIBC）；高级别尿路上皮癌5例，低级别尿路上皮癌9例。术后3个月复查，复发者3例，未复发者7例，未复查者4例。远期随访时间为[42（20.5，65）]个月，其中死亡患者2例，失访患者2例，其余10例患者皆存活，但1例已出现肝转移。

结论

HIV阳性膀胱癌患者发病年龄较HIV阴性膀胱癌患者小，但病理级别与病理分期无统计学差异。

关键词: 人类免疫缺陷病毒, 膀胱癌, 治疗
Objective

To investigate the preoperative and postoperative laboratory examination results, pathological types, treatment methods and prognosis of patients with human immunodeficiency virus (HIV) infection and bladder cancer, and to provide clinical reference for the prevention and treatment of HIV positive patients with bladder cancer.

Methods

Total of 14 patients with HIV infection complicated with bladder cancer and treated in Beijing Ditan Hospital, Capital Medical University and Beijing Beijing You’an Hospital, Capital Medical University from December 2013 to April 2021 were enrolled. The retrospective study parameters included HIV infection route, regular treatment, HIV viral load and number of CD4+ T lymphocytes prior to surgery, and preoperative laboratory examination; details specific to bladder cancer included pathological stage and grade, treatment, recurrence at 3 months and longer-term follow-up. The statistical analysis were carried out by descriptive statistical methods.

Results

Among the 14 patients, 13 cases (93%) were male and 1 case (7%) was female, with an average age of (48.93 ± 13.83) years old. There were 9 patients who received regular antiretroviral therapy after HIV infection, and the other 5 patients did not receive regular treatment. Preoperative laboratory tests: CD4+ T lymphocytes: 368 (254, 580) cells/μl, white blood cells: 6.17 (4.94, 7.02) × 109/L, red blood cells: 4.16 (3.70, 4.68) × 1012/L, platelet: (199 ± 60.05) × 109/L, creatinine: 70.85 (65.50, 75.25) μmol/L, albumin: 41.50 (39.60, 44.45) g/L. All the 14 patients received surgical treatment, including 11 patients with bladder tumor resection and 3 patients with bladder cancer radical surgery. Three cases were pathologically invasive bladder cancer (MIBC), and the other 11 cases were non-invasive bladder cancer (NMIBC). There were 5 cases with high-grade urothelial carcinoma and 9 cases with low-grade urothelial carcinoma. Three months after operation, there were 3 cases of recurrence, 7 cases of non-recurrence and 4 cases not reviewed. During the long-term follow-up for 42 (20.5, 65) months, 2 cases died, 2 cases were lost to follow-up, and the other 10 cases survived, but 1 case occured liver metastasis.

Conclusions

Patients with HIV-positive bladder cancer had lower age of onset than patients with HIV-negative bladder cancer, but there was no difference between different pathological grades and stages.

Key words: Human immunodeficiency virus, Bladder cancer, Treatment
表1 14例HIV感染者合并膀胱癌患者一般资料
临床资料 数值
男/女（例） 13/1
年龄[ ± s，岁] 48.93 ± 13.83
传播途径[例（%）]  
同性 6（42.86）
异性 3（21.43）
不详 5（35.71）
经ART [例（%）]  
是 9（64.29）
否 5（35.71）
术前HIV检测[例（%）]  
未检测 4（28.57）
低于检测下限 7（50.00）
< 40拷贝/μl 1（7.14）
56拷贝/μl 1（7.14）
术前CD4+ T淋巴细胞计数[M（P25，P75），个/μl] 368（254，580）
术前CD4+ T淋巴细胞分布[例（%）]  
> 200个/μl 12（85.72）
< 200个/μl 1（7.14）
未检测 1（7.14）
表2 14例HIV感染合并膀胱癌患者的术前实验室指标
实验室指标 数值
白细胞  
计数[M（P25，P75），× 109/L] 6.165（4.935，7.020）
低于参考值下限[例（%）] 3（21.43）
红细胞  
计数[M（P25，P75），× 109/L] 4.160（3.695，4.678）
低于参考值下限[例（%）] 6（42.86）
血小板  
计数（ ± s，× 109/L） 199.00 ± 60.05
低于参考值下限[例（%）] 1（7.14）
肌酐  
水平[M（P25，P75），μmol/L] 70.85（65.5，75.25）
高于参考值上限[例（%）] 1（7.14）
白蛋白  
水平[M（P25，P75），g/L] 41.5（39.6，44.45）
低于参考值下限[例（%）] 4（28.57）
表3 14例HIV合并膀胱癌患者的治疗、随访和结局
指标 例（%）
TNM分期  
NMIBC 11（78.57）
MIBC 3（21.43）
病理分级  
级别 5（35.71）
低级别 9（64.29）
手术方式  
膀胱肿瘤电切 11（78.57）
膀胱癌根治 3（21.43）
术后3个月复查  
复发电切 3（21.43）
未复发 7（50.00）
未复查 4（28.57）
结局  
存活 10（71.44）
进展为MIBC 1（7.14）
死亡 2（14.28）
失访 2（14.28）
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