AIDS患者隐球菌相关免疫重建炎症综合征的治疗和管理  

The therapeutics and management of cryptococcus-related immune reconstitution inflammatory syndrome in AIDS patients

作　　者：惠疆锦 朱彪[1] Hui Jiangjin;Zhu Biao(Department of Infectious Diseases,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,National Clinical Research Center for Infectious Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属第一医院感染病科,传染病诊治国家重点实验室,感染性疾病诊治协同创新中心,国家临床医学研究中心,杭州310006

出　　处：《中华临床感染病杂志》2021年第3期222-227,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：艾滋病功能性治愈策略和临床研究(2017ZX10202102-002-002);示范区"重大传染病规模化现场流行病学调查和干预"质量控制研究(2018ZX10715104)。

摘　　要：获得性免疫缺陷综合征(Acquired immune deficiency syndrome,AIDS)患者由于机体细胞免疫功能的严重缺陷,可发生各种机会性感染。隐球菌病是AIDS患者常见的严重机会性感染。随着高效抗逆转录病毒治疗(High activity antiretroviral therapy,HAART)在全球范围内的广泛应用,AIDS相关隐球菌病病死率明显降低。但部分患者在启动HAART后,临床症状反复和加重,机体出现对隐球菌抗原过度免疫调节的炎症反应,称为隐球菌相关免疫重建炎症综合征(Cryptococcus-related immune reconstitution inflammatory syndrome,C-IRIS),严重影响患者生活质量和预后。本文就AIDS患者C-IRIS的临床特征、发病机制、治疗及管理策略进行综述。Acquired immune deficiency syndrome(AIDS)can cause various opportunistic infections clinically due to severe defects in the body’s cellular immune function.Cryptococcosis is a common serious opportunistic infection in AIDS patients.With the promotion and popularization of high activity antiretroviral therapy(HAART)programs worldwide,the mortality rate of AIDS-related cryptococcosis has been significantly decreased.After initiating antiviral therapy,some patients experienced recurrence and aggravation of clinical symptoms during anti-cryptococcal treatment.The body has an inflammatory response to the excessive immune regulation of cryptococcal antigens,which is called cryptococcus-related immune reconstitution inflammatory syndrome(C-IRIS).C-IRIS seriously affects the quality of life and prognosis of patients.This article reviews the clinical features,pathogenesis and the latest treatment and management strategies of C-IRIS in AIDS patients.

关 键 词：获得性免疫缺陷综合征 隐球菌病 免疫重建炎症综合征 治疗 管理 

分 类 号：R512.91[医药卫生—内科学]