110例人类免疫缺陷病毒感染及获得性免疫缺陷综合征患者合并血小板减少症临床分析

目的:了解人类免疫缺陷病毒感染或获得性免疫缺陷综合征(HIV/AIDS)患者合并血小板减少症的临床特点。方法:回顾性分析2009年8月至2012年12月上海市公共卫生临床中心收治的110例HIV/AIDS合并血小板减少症患者的临床资料,分析血小板减少的病因、治疗及转归。结果:110例患者中机会性感染49例(44.5%),乙型肝炎病毒和(或)丙型肝炎病毒(HBV/HCV)感染26例(23.6%),HIV相关免疫性血小板减少性紫癜(HIV-ITP)20例(18.2%),药物相关骨髓抑制7例(6.4%),AIDS相关肿瘤及其他疾病8例(7.3%)。以血小板减少为HIV/AIDS首发临床表现者10例。82.7%(91/110)的患者同时合并其他血液学异常,包括贫血(68.2%)或白细胞减少(58.2%)。81.3%的HIV-ITP患者对激素及静脉注射免疫球蛋白治疗敏感,治疗无效或复发者长期抗病毒治疗后血小板缓慢上升。结论:HIV/AIDS患者血小板减少常见病因有机会性感染、合并HBV/HCV感染、HIV-ITP、药物相关骨髓抑制等。HIV-ITP可为HIV/AIDS患者首要临床表现,其根本治疗措施为抗病毒治疗。血小板减少患者常同时合并贫血和(或)白细胞减少,多重血液学异常预示病情严重,需要积极处理原发病。

Analysis of 110 cases of thrombocytopenia in human immunodeficiency virus infection/acquired immunodeficiency syndrome patients

Objective To elucidate the characteristics of thrombocytopenia in human immunodeficiency virus infection/acquired immunodeficiency syndrome（HIV/AIDS） patients.Methods The medical records of 110 cases of thrombocytopenia in HIV/AIDS patients admitted in Shanghai Public Health Clinical Center between August 2009 and December 2012 were retrospectively analyzed,including the cause,treatment and prognosis of thrombocytopenia.Results Of the 110 cases,49（44.5%） were diagnosed as having opportunistic infections,26（23.6%） were co-infected with hepatitis B virus（HBV） and（or） HCV,20（18.2%） had HIV related immune thrombocytopenic purpura（HIV-ITP）,7（6.4%） had drug-induced bone marrow depression,and 8（7.3%） had AIDS related tumor and other diseases.Thrombocytopenia was the first clinical manifestation of AIDS in 10 patients.Eighty-two point seven percent（91/110） of patients with thrombocytopenia had other hematologic abnormalities,including anemia（68.2%） and leucopenia（58.2%）.Eighty-one point three percent of HIV-ITP patients had good response to corticosteroids and intravenous immunoglobulin（IVIg）;those with no response or relapse had a gradual rise of platelets after long term antiviral therapy.Conclusions Opportunistic infection,co-infection with HBV/HCV,HIV-ITP and drug-induced bone marrow depression are common causes of thrombocytopenia in HIV/AIDS.ITP may be the first clinical manifestation of HIV/AIDS.Antiviral therapy is the primary treatment regimen.Patients with dual or triple hematologic abnormalities are usually seriously diseased,and treatment should be focused on the underlying disease.