HIV 阳性药疹患者 CD4＋、CD8＋T 细胞水平以及临床特征分析  

CD4＋ and CD8＋ T cell levels as well as clinical features in HIV-positive patients with drug eruption

作　　者：陈官芝[1] 张洋[1] 路晓琳[2] 时培荣 徐光勇[4] 孙梦绮 李志涛 刘信桥[3] 周惠[4] 赵娟[4] 

机构地区：[1]青岛大学附属医院皮肤科,266003 [2]北京大学中国药物依赖性研究所 [3]青岛海慈医疗集团皮肤科 [4]青岛市传染病医院皮肤性病科 [5]青岛市市北区疾病预防控制中心 [6]青岛市市南区疾病预防控制中心

出　　处：《中华皮肤科杂志》2015年第12期853-855,共3页Chinese Journal of Dermatology

摘　　要：目的：探讨病毒感染在 HIV 阳性药疹患者发病中的作用及抗病毒治疗效果。方法回顾性分析接受“高效抗逆转录病毒治疗”的11例 HIV 阳性药疹患者及同期76例 HIV 阳性非药疹患者临床资料以及基线 CD4＋、CD8＋T 细胞计数和 CD4/CD8比值。结果11例 HIV 阳性药疹患者均符合轻型药疹，潜伏期8～34（14.00±8.10）d，其中7例出现肝功能损伤，与皮损严重程度不一致，未停用抗病毒药物并经抗过敏治疗后病情好转。11例 HIV 阳性药疹患者基线 CD4＋T 细胞计数为42～810（493.00±245.68）个/μl，高于75例 HIV 阳性非药疹患者[11～814（347.81±167.00）个/μl，t =647.50，P ＜0.05]，基线 CD4＋T 细胞计数降低者比例（3/11）低于HIV 阳性非药疹患者[64.00％（48/75），字2=3.95，P ＜0.05]。10例 HIV 阳性药疹患者基线 CD8＋T 细胞计数[（1472.30±858.55）个/μl]与同期69例 HIV 阳性非药疹患者[（1356.59±684.06）个/μl]相比，差异无统计学意义（P 〉0.05），基线 CD4/CD8比值（0.40±0.27）与 HIV 阳性非药疹患者（0.29±0.16）差异无统计学意义（P 〉0.05），基线 CD4/CD8值低于正常下限者率（9/10）与 HIV 阳性非药疹患者[98.55％（68/69）]差异亦无统计学意义（P 〉0.05）。结论接受“高效抗逆转录病毒治疗”的 HIV 阳性药疹患者具有更长的潜伏期，即使轻型药疹亦可伴肝功能异常等系统损害；相对较高 CD4＋T 细胞计数可能是 HIV 阳性者药疹发生或加重的危险因素。Objective To explore the role of viral infection in the development of drug eruption in patients with HIV infection, and to evaluate the efficacy of antiviral treatment. Methods This study enrolled 87 HIV-positive patients, including 11 with and 76 without drug eruption, all of whom received highly active antiretroviral therapy（HAART）. Clinical data on, baseline CD4＋ and CD8＋ T cell counts and CD4/CD8 ratio in these subjects were retrospectively analyzed. Results The severity of drug eruption was mild in the 11 HIV-positive patients, with a mean latency period of （14.00 ± 8.10）（range, 8 - 34）days. Of the 11 patients with drug eruption, 7 had liver function impairment, which was not in accordance with the severity of skin lesions. Drug eruption was controlled in all the 11 patients after anti-anaphylactic treatment without withdrawal of antiviral drugs. Compared with 75 HIV-positive patients without drug eruption, the 11 HIV-positive patients with drug eruption showed significantly increased baseline CD4 ＋ T cell counts （493.00 ± 245.68 （range, 42 - 810）/μl vs. 347.81 ± 167.00 （range, 11 - 814）/μl, t = 647.50, P ＆lt; 0.05）, but decreased proportion of patients with baseline CD4＋ T cell counts below the lower limit of normal（3/11 vs. 48/75（64.00%）, X2 = 3.95, P ＆lt; 0.05）. There were no significant differences between 10 patients with drug eruption and 69 patients without drug eruption in the baseline CD8＋ T cell count（1472.30 ± 858.55/μl vs. 1356.59 ± 684.06/μl, P 〉 0.05）, CD4/CD8 ratio（0.40 ± 0.27 vs. 0.29 ± 0.16, P 〉 0.05）, or percentage of patients with a CD4/CD8 ratio below the lower limit of normal （9/10 vs. 68/69 （98.55%）, P 〉0.05）. Conclusions The latency period of drug eruption seems to be long in HIV-positive patients receiving HAART, and mild drug eruption can be complicated by liver function impairment in the patients. Relatively high CD4 ＋ counts may be a risk factor for the development and aggravation of drug eruption in

关 键 词：抗逆转录病毒治疗 高效 CD4 阳性 T 淋巴细胞 CD8 阳性 T 淋巴细胞 疱疹病毒科 药疹 

分 类 号：R512.91[医药卫生—内科学]