CLINICAL SPECTRUM OF HTLV-I IN SOUTH FLORIDA
CLINICAL SPECTRUM OF HTLV-I IN SOUTH FLORIDA
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DOI：
10.1097/00042560-199504120-00006
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发表时间：
1995-04-15
期刊：
影响因子：
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通讯作者：
POIESZ, B
中科院分区：
文献类型：
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作者：
HARRINGTON, WJ;UCAR, A;POIESZ, B
从1988年1月至1993年3月，在迈阿密大学共对113例人类T细胞白血病病毒1型（HTLV-1）感染患者进行了评价。40例患者被确定为成人T细胞白血病/淋巴瘤（ATLL）和63例HTLV-I相关性脊髓病（HAM）。3例伴ATLL和HAM。在研究期间，两名HAM患者合并感染人类免疫缺陷病毒1型（HIV-I），发生了克隆性淋巴组织增生性疾病。ATLL患者预后不良;已使用包括高剂量细胞毒性药物在内的多种化疗方案，对生存率的影响较小。我们的大多数患者目前都在接受实验性方案治疗。风湿性或自身免疫性疾病被确定，主要是在HAM患者，和少数发展免疫缺陷的情况下，其他可定义的病因。大多数患者是来自加勒比海盆地流行地区的移民，尽管也认识到许多美国人。HTLV-I/II感染被诊断为血清学和HTLV-I型聚合酶链反应（PCR）或改良的蛋白质印迹法时，DNA样本不可用。在40例ATLL患者中的24例中，对从外周血淋巴细胞或肿瘤组织提取的DNA进行Southern印迹杂交，证实克隆HTLV-Ⅰ整合。在南佛罗里达，ATLL和HAM现在经常出现。由于HTLV-I感染与发生ATLL的4%终身风险和发生HAM的额外0.25%终身风险相关，因此这里必须存在大量无症状感染个体。自身免疫性疾病和免疫缺陷状态在这些患者中并不少见。不寻常的临床表现，现在被确认在那些共同感染HTLV-I和HIV-I。
A total of 113 patients with infection due to human T-cell leukemia virus type 1 (HTLV-I) were evaluated at the University of Miami from January 1988 to March 1993. Forty patients were identified with adult T-cell leukemia/lymphoma (ATLL) and 63 with HTLV-I-associated myelopathy (HAM). Three had concomitant ATLL and HAM. Two HAM patients co-infected with human immunodeficiency virus type 1 (HIV-I) developed clonal lymphoproliferative disease during the study period. Patients with ATLL have a poor prognosis; multiple chemotherapy regimens including high-dose cytotoxic agents have been utilized with a small impact on survival. Most of our patients are currently treated with experimental regimens. Rheumatologic or autoimmune illnesses were identified, mostly in HAM patients, and a small number developed immunodeficiencies in the absence of other definable etiologic factors. Most of the patients were immigrants from areas of endemicity in the Caribbean basin, although many Americans were also recognized. HTLV-I/II infection was diagnosed serologically and typed as HTLV-I by polymerase chain reaction (PCR) or a modified Western blot when a DNA sample was not available. In 24 of 40 patients with ATLL, Southern blot hybridization performed on DNA extracted from peripheral blood lymphocytes or tumor tissue demonstrated clonal HTLV-I integration. In South Florida, ATLL and HAM are now seen frequently. Since HTLV-I infection is associated with a 4% lifetime risk of developing ATLL and an additional 0.25% lifetime risk for developing HAM, a large pool of asymptomatically infected individuals must exist here. Autoimmune conditions and immunodeficiency states are not uncommon in these patients. Unusual clinical presentations are now being recognized in those co-infected with HTLV-I and HIV-I.