癌症与艾滋病相关的免疫抑制在成年人的关联
M Frisch1, R J Biggar, E A Engels
1Danish Epidemiology Science Center, Statens Serum Institut, 5 Artillerivej, DK-2300 Copenhagen S, Denmark. mfr@ssi.dk
JAMA
|April 13, 2001
概括
研究了人类免疫缺陷病毒 (HIV) 和获得免疫缺陷综合征 (AIDS) 患者的癌症. 虽然一些非艾滋病定义的癌症显示出过度风险,但只有像霍奇金病这样的特定类型可能与免疫抑制有关.
科学领域:
- 流行病学 流行病学
- 免疫学 免疫学 免疫学
- 在瘤学瘤学.
背景情况:
- 需要进行大规模的研究,以确定除了卡波西肉瘤,非霍奇金淋巴瘤和宫癌之外的癌症,这些癌症在艾滋病毒/艾滋病患者中可能会发生更高的发病率.
- 了解艾滋病毒/艾滋病患者的癌症模式对于公共卫生倡议和临床管理至关重要.
研究的目的:
- 为了调查艾滋病毒/艾滋病诊断成年人中的总体癌症发病率.
- 在艾滋病毒/艾滋病患者群体中,区分直接与免疫抑制相关的癌症和具有其他潜在原因的癌症.
主要方法:
- 分析了1978年至1996年间美国11个不同地区302,834名成年人的基于人口的艾滋病和癌症登记数据.
- 对各种癌症的相对风险 (RRs) 的计算,通过将观察到的病例与基于一般人口率的预期数量进行比较.
- 使用三个标准来定义免疫抑制相关的癌症:总体RR升高,艾滋病后RR升高,以及艾滋病发病前期的RR趋势增加.
主要成果:
- 在艾滋病确定的癌症和非艾滋病确定的癌症中都观察到统计学上显著的过度 (总体RR,2.7).
- 满足所有三个免疫抑制标准的特定癌症包括霍奇金病 (RR, 11.5),肺癌 (RR, 4.5),阴茎癌 (RR, 3.9),软组织恶性瘤 (RR, 3.3),唇癌 (RR, 3.1) 和丸半瘤 (RR, 2.0).
- 霍奇金病亚型 (混合细胞和淋巴细胞枯竭) 显示出特别高的相对风险.
结论:
- 大多数非艾滋病确定的癌症在艾滋病毒/艾滋病患者中发生率过高,似乎并不是直接由免疫抑制的进展引起的.
- 诸如大量吸烟 (肺癌),暴露于人类乳头瘤病毒 (阴茎癌) 或错误分类 (软组织恶性瘤) 等因素可能解释一些过度行为.
- 霍奇金病 (特别是混合细胞和淋巴细胞枯竭亚型),以及潜在的唇癌和丸半瘤,需要进一步调查是否与艾滋病毒相关的免疫抑制有真正的联系.
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