对539例HIV感染者皮肤黏膜表现的临床分析

目的通过研究H IV感染者/AIDS患者皮肤黏膜表现的种类数及严重程度及其与CD4+T淋巴细胞计数、CD4+/CD8+比值的关系,评估皮肤黏膜病变作为预测和评估患者免疫状态的临床指标的可行性。方法对北京佑安医院2001年5月~2006年4月收集的539例住院及门诊H IV感染者/AIDS患者的临床资料作回顾性研究,采用流式细胞仪技术检测350例出现不同皮肤黏膜表现及189例无皮肤黏膜表现患者的CD4+T细胞计数、CD4+/CD8+比值,观察H IV感染人群中各种皮肤病的发生率,并研究出现皮肤病的种类数、严重程度与艾滋病患者免疫功能的相关性。结果H IV阳性患者的皮肤病发生率为65%,其中口腔黏膜念珠菌感染最常见。H IV阳性有皮肤黏膜表现组CD4+T细胞计数的平均数与CD4+/CD8+比值(分别为53.04个/μL与0.202 4)明显低于无皮肤黏膜表现组(分别为281.97个/μL与0.312 9),2组间比较差异具有明显的统计学意义(P<0.05),且CD4+T细胞计数与所患皮肤病的种类数及严重程度呈负相关。结论H IV感染者/AIDS患者的常见皮肤病临床表现,即患者皮肤疾病的种类数、发生率及严重程度与CD4+T细胞计数呈负相关,某些皮肤黏膜表现可以作为预测和评估资源有限国家患者免疫状态的临床指标。

Clinical Analysis of Skin and Mucosa Manifestations in 539 Patients with HIV/AIDS

Objective To investigate skin and mucosa manifestations as clinical markers of underlying status in HIV infection by assessment of skin diseases,and neusurement CD₄⁺ lymphocyte count and CD₄⁺/CD₈⁺ ratio.Methods Retrospective studies were performed,in 539 inpatients and outpatients in Beijing Youan Hospital from May 2001 to April 2006.CD₄⁺ lymphocyte count and CD₄⁺/CD₈⁺ ratio were measured by flowcytometry in 189 asymptomatic HIV patients and 350 HIV patients with various skin manifestations respectively.The prevalence of skin disease in HIV infection and its relationship to the degree of immuno-suppression were studied as well.Results Average CD₄⁺ T cell count and CD₄⁺/CD₈⁺ ratio in symptomatic HIV-infected individuals(153.04/μL and 0.2024 respectively) were significantly lower than that of HIV-infected asymptomatic individuals(281.97/μL and 0.3129 respectively)(P<(0.05)).Oral mucosal candidiasis was the commonest skin manifestation in 36% HIV-positive patients.Conclusion There was an inversion ratio between the CD₄⁺ T cell counts and the incidence,severity and the number of skin diseases in the HIV/AIDS patients.Some cutaneous manifestations of HIV carriers can be considered as good clinical markers to predict and assess the underlying immune status in resource-limited countries.