中国麻风皮肤病杂志 ›› 2022, Vol. 38 ›› Issue (11): 780-784.doi: 10.12144/zgmfskin202211780

• 论著 • 上一篇    下一篇

40例HIV合并重症药疹临床分析

张维,李奇穗,邓长刚,黄薇,孙艳雨,袁婧   

  1. 重庆市公共卫生医疗救治中心感染科，重庆，400036
  • 出版日期:2022-11-15 发布日期:2022-10-25

Clinical analysis of 40 cases of HIV complicated with severe drug eruption

ZHANG Wei, LI Qisui, DENG Changgang, HUANG Wei, SUN Yanyu, YUAN Jing   

  1. Chongqing Public Health Medical Center, Infectious Disease Department, Chongqing 400036, China
  • Online:2022-11-15 Published:2022-10-25

PDF (PC)

143

摘要： 目的：分析HIV合并重症药疹的临床特征及治疗措施。方法：回顾性分析2017年1月至2020年12月重庆市公共卫生医疗救治中心感染科收治的HIV合并重症药疹住院患者的临床资料，比较不同类型重症药疹患者之间在人口学资料、过敏史、致敏药物、临床特征及预后等方面的差异。结果：本研究共纳入40例HIV合并重症药疹患者，其中重型多型红斑（SJS） 23例，剥脱性皮炎（ED） 15例，大疱性表皮松解症（TEN） 2例；平均年龄为(48.7±12.8)岁，男性为主，占85.0%。该组患者CD4+T淋巴细胞计数中位值为113（14~713）个/μL；常见致敏药物为：依非韦伦、磺胺、中药制剂；皮肤瘙痒（80.0%）、发热（52.5%）为其常见临床表现；90%患者出现黏膜受累，82.5%肝脏受累， 65%患者合并感染。三种类型重症药疹比较，仅在发热、合并感染方面有统计学差异（均P＜0.05）。所有患者均使用糖皮质激素治疗，平均最大剂量(78±12.6)mg/d，65%的患者同时联合使用了人免疫球蛋白，使用平均总剂量为(111.4±22.9)g。共3例患者死亡，占7.5%，死亡原因非皮疹本身所致，均为艾滋病合并症所致。结论： HIV合并重症药疹以中年男性多见，平均潜伏期10天，且以使用依非韦伦、复方磺胺甲恶唑、中药制剂及结核药患者常见，早期足量使用糖皮质激素联合人免疫球蛋白冲击治疗疗效较好。

关键词: HIV, 重症药疹；临床特征；治疗措施

Abstract: Objective: To analyze the clinical features and treatment measures of HIV complicated with severe drug eruption. Methods: A retrospective analysis was carried out on the clinical data of inpatients with HIV complicated with severe drug eruption admitted to Chongqing Public Health Medical Center from January 2017 to December 2020. Results: A total of 40 patients were included in this study, including 23 cases of SJS, 15 cases of ED and 2 cases of TEN. The mean age was 48.7±12.8 years, and 85% (34/40) of men. Top three sensitization drugs: efevirenz, sulfanilamide and traditional Chinese medicine preparation. The most common manifestations were fever (52.5%) and pruritus (80%). 90% had mucosal involvement, 82.5% had liver involvement. 65% had cutaneous infections. The median of CD4 count was 113/μL (from 14 to 713/μL). There were significant differences of fever and cutaneous infection among the three kinds of severe drug eruption (Ps<0.05). The mean maximum dose of glucocorticoid was 78±12.6 mg/d, and the mean total dose of immunoglobulin was 111.4±22.9 g. Three patients died, the cause of death was not drug eruption, but complications of AIDS. Conclusion: HIV complicated with severe drug outbreak was more common in middle-aged men, with an average incubation period of about 10 days, and it was common in patients who used efevirenz, cotrimoxazole, traditional Chinese medicine preparations and tuberculosis drugs. Early sufficient use of glucocorticoid combined with immunoglobulin shock therapy had better efficacy.

Key words: HIV, severe drug eruption, clinical characteristics, treatment measures