抗病毒治疗致药疹的HIV/AIDS患者97例临床分析  

Clinical analysis of 97 cases with human immunodeficiency virus infection/acquired immune deficiency syndrome complicated with drug eruption caused by antiretroviral treatment

作　　者：王丽君[1] 战寒秋[1] Wang Lijun;Zhan Hanqiu(Department of Pharmacy,Beijing Ditan Hospital,Capital Medical Universit)

机构地区：[1]首都医科大学附属北京地坛医院药剂科,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2018年第4期392-396,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：感染病科国家临床重点专科建设项目

摘　　要：目的分析抗逆转录病毒药物所致HIV/AIDS患者药疹的临床资料,为药疹防治提供参考。方法采用回顾性分析方法,收集2008年11月至2016年12月首都医科大学附属北京地坛医院收治的行抗逆转录病毒药物治疗(ART)而引起药疹的HIV/AIDS患者临床资料,将患者分为依非韦伦(EFV)组(63例)和奈韦拉平(NVP)组(34例),对发生药疹患者的年龄、性别、合并用药、过敏史、药疹分级、潜伏期、CD4+T淋巴细胞计数、嗜酸性粒细胞百分比(EO%)以及治疗措施等进行分析。结果 97例药疹患者中男性87例,女性10例,年龄18~68岁,合并用药6~20种。有过敏史者23例,69例(74.19%)患者伴EO%升高。NVP组患者重症药疹发生率(47.06%)显著高于EFV组患者(14.29%),差异有统计学意义(χ~2=12.398、P <0.001)。70.10%(68/97)患者药疹发生在ART治疗2周内,其中EFV组患者中51例(81.95%),NVP组患者中17例(50.00%),差异无统计学意义。治疗2~4周内,NVP组患者药疹发生率显著高于EFV组(χ~2=4.750、P=0.029)。CD4+T细胞≤200个/μl患者易发生药疹(54/97,55.67%),EFV组患者药疹发生率高于NVP组,差异有统计学意义(χ~2=4.705,P=0.030);CD4+T细胞为201~499个/μl患者中NVP组药疹发生率显著高于EFV组(χ~2=7.109、P=0.008);CD4+T细胞≥500个/μl患者中两组药疹发生率差异无统计学意义。97例药疹患者经治疗均好转出院。NVP组停药者显著多于EFV组(79.41%vs. 22.22%,χ~2=7.109,P=0.008);NVP组接受甘草酸制剂和糖皮质激素治疗的药疹患者比例显著高于EFV组,差异具有统计学意义(44.44%vs. 70.59%,χ~2=6.069、P=0.014)。结论尽管EFV和NVP引起皮疹特点各异,但通常均发生在抗病毒治疗4周内,NVP更易引起重症皮疹;CD4+T≤200个/μl患者更易发生药疹,合并用药种类多为危险因素,药疹发生时患者EO%可升高,EO%可作为监测皮疹发生的指标。Objective To investigate the clinical data of drug eruption induced by antiretroviral drugs in patients with human immunodeficiency virus infection/acquired immune deficiency syndrome（HIV/AIDS）, and to provide reference for the prevention and control. Methods The clinical data of 97 HIV/AIDS patients with drug eruption induced by antiretroviral therapy（ART） in Beijing Ditan Hospital, Capital Medical University from November 2008 to December 2016 were analyzed, retrospectively, and patients were devided into efavirenz（EFV） group（63 cases） and nevirapine（NVP） group（34 cases）. The age, sex, drug combination, allergies, rashes, incubation period, CD4＋ T lymphocyte count, eosinophil percentage（EO%） and treatments were analyzed. Results The 97 cases aged from 18 to 68 years, including 87 male and 10 female. There were 23 patients with a history of allergies and 69（74.19%） patients with elevated EO%. The difference of the incidence of serious rash had significant difference（χ^2 = 12.398, P 〈0.001） between the two group（47.06% vs. 14.29%）. There were 70.10% patients（68/97） had a rash within two weeks of ART treatment, with 51 cases（81.95%） in EFV group and 17 cases（50.00%） in NVP group, with no significant difference（P 0.05）. The incidence of rash in NVP group was higher than that of EFV group after 2 to 4 weeks of ART treatment（χ^2 = 4.750, P = 0.029）. And 55.67%（54/97） patients with CD4^＋ T ≤ 200 cells/μl broke out rashes, and EFV group was higher than that of NVP group（χ^2 = 4.705, P = 0.030）. Among patients with CD4^＋ T 201-499 cells/μl, the incidence of rash in NVP group was higher than that in EFV group, with significant difference（χ^2 = 7.109, P = 0.008）. Among patients with CD4^＋ T 〉500 cells/μl in both group, there was no significant difference（P〉 0.05）. All patients improved and were discharged after treatment. The percentage of patients who withdrawed drug in NVP group was significantly higher than that of EFV gr

关 键 词：获得性免疫缺陷综合征 抗逆转录病毒药物 药疹 

分 类 号：R512.91[医药卫生—内科学]