HIV/AIDS病人合并痒疹的临床病理研究  

Clinical and histopathological features of pruritic papular eruptions among HIV/AIDS patients

作　　者：董天祥[1] 刘彤云[1] 曹应葵 李玉叶[1] 杨吉林[2] 

机构地区：[1]昆明医科大学第一附属医院皮肤性病科,昆明650032 [2]昆明医科大学第一附属医院重症医学科,昆明650032

出　　处：《中国艾滋病性病》2017年第6期485-488,共4页Chinese Journal of Aids & STD

摘　　要：目的了解痒疹(PPE)在艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)中的发生情况、临床和组织病理特点,以及患者的免疫功能。方法收集乌干达金贾医院皮肤科及艾滋病科2年多HIV/AIDS病人的PPE临床资料,部分进行CD4^+T淋巴细胞(简称CD4细胞)检查及皮损组织病理检查。结果 1 429例HIV/AIDS病人中,患PPE 305例(21.3%)。男∶女为1∶1.48;年龄19~60岁,中位年龄35岁[四分位数间距(IRQ)28~40岁]。PPE在未接受抗反转录病毒治疗(ART)的HIV/AIDS病人中的患病率为33.3%(279/837),在行ART病人中的患病率为4.4%(26/592)。279例未接受ART病人的中位病程6个月(IRQ 2-12个月)。PPE表现为瘙痒剧烈的丘疹、结节性痒疹,全身对称发生;42例(13.8%)PPE为HIV感染的首发表现;31例PPE主要病理改变为真皮血管周围有显著的单核细胞及嗜酸性粒细胞致密浸润;217例PPE患者的CD4细胞计数为4~770个/mm^3,中位CD4细胞计数为41个/mm^3(IQR:21~143个/mm^3),84.2%的病例的CD4细胞计数<200个/mm^3。结论 PPE在HIV/AIDS病人中发病率高,ART能改善PPE并降低患病率。PPE的主要病理改变为真皮血管周围显著的单核细胞及嗜酸性粒细胞浸润。Objective To study the clinical and histopathological features of PPE（pruritic popular eruptions） a- mong HIV/AIDS patients, and their relationships with CD4 counts. Methods A cross-sectional study was conducted for 2 years （Aug. 2005-Jul, 2007） at the skin clinic and HIV/AIDS clinic in Jinjia hospital of Uganda, with 1429 HIV/AIDS patients involved. After informed consent, data were collected including skin disorders, HIV status, CD4 counts through physical examination and laboratorial methods. Punch biopsies of skin lesions were taken for histopathological features. Results Out of 1429 HIV/AIDS patients, 305（21.34%） were diagnosed as PPE with the ages between 19-60 years and the median age of 35（IRQ 28 - 40） years, and male/female ratio of 1：1.48. 42 （13.8 ; ） diagnosed as PPE had initial symptoms of cutaneous disease of HIV infection. The clinical features of PPE were observed as a symmetrical distribution of multiple papules and prurigos with intensive itch on the face, limbs, and trunk, especially the extensor surfaces of the limbs. The prevalence of PPE among those without ART was 33.33% and with ART 4.39%. The duration of PPE among those without ART was from the 1^st month to the 72na month with a median time of 6（IRQ 2-12） months. Among all the 305 PPE cases, 217 had the data of CD4 counts, with 55.3% less than 50 cells/ram3, 28.9% between 50 and 199 cells/mm3, and only 15.7% at least 200 cells/ mm3. 31 （10.16 %） cases received histologic examinations. The predominant histopathological features were spongi- osis, parakeratosis and dermal perivascular mononuclear cell infiltrated with numerous eosinophils. Conclusion Our study reveals that PPE are common cutaneous manifestations among HIV/AIDS patients with most of them presen- ting as a widespread chronic papules and prurigos. Skin clinic may perform as a window to find newly HIV infected patients, and symptoms of PPE can not only act as markers of HIV infection, but also reflect the patient＇s advancing immune suppression.

关 键 词：艾滋病病毒感染者/艾滋病病人 痒疹 临床表现 组织病理 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]