获得性免疫缺陷综合征患者免疫重建炎症综合征相关Graves’病5例并文献复习

Five cases with acquired immunodeficiency syndrome and Graves’disease associated with immune reconstitution inflammatory syndrome and literature review

目的提高对获得性免疫缺陷综合征(AIDS)患者高效抗逆转录病毒治疗(HAART)后免疫重建炎症综合征相关Graves’病的认知并早期诊断治疗。方法回顾性分析2009年1月至2019年4月首都医科大学附属北京地坛医院收治的AIDS患者HAART后发生免疫重建炎症综合征相关Graves’病患者共5例的临床资料和诊疗方法。结果入组5例患者诊断Graves’病时年龄为19~56岁,平均年龄35岁,其中4例为男性,HAART起始到出现Graves’病症状的中位时间22个月,HAART前基线及Graves’病诊断时外周血中位CD4^(+)T细胞计数分别为2个/μl和359个/μl,Graves’病诊断时所有患者均实现了血浆HIV完全抑制。与普通Graves’病相似,最常见症状是心悸、乏力,1例患者合并Graves’眼病,1例患者伴甲状腺功能亢进性周期性麻痹及室性心动过速。5例患者均应用甲巯咪唑(MMI)治疗,其中4例治愈,1例患者复发应用碘131治愈。结论Graves’病是AIDS患者HAART后免疫重建炎症综合征的表现形式之一,相对迟发,发生于晚期免疫抑制患者免疫功能快速恢复之后,此类患者出现与免疫功能恢复不相匹配的乏力等甲状腺毒症症状时临床医师需考虑到该疾病可能。

Objective To improve the understanding,early diagnosis of Graves’disease associated with immune reconstitution inflammatory syndrome after highly active antiretroviral therapy(HAART)in patients with acquired immunodeficiency syndrome(AIDS).Methods Total of 5 cases of Graves’disease associated with immune reconstitution inflammatory syndrome after HAART admitted to Beijing Ditan Hospital,Capital Medical University from January 2009 to April 2019 were enrolled,the clinical data and diagnosis and treatment methods were analyzed,retrospectively.Results The age of 5 cases at diagnosis of Graves’disease was 19-56 years old(with the average age 35 years old).Four of them were male.The median time from onset of HAART to onset of Graves’disease symptoms was 22 months.The median CD4^(+)T cell counts in peripheral blood before HAART and at the time of diagnosis of Graves’disease were 2 cells/μl and 359 cells/μl,respectively.When diagnosis as Graves’disease,all patients achieved complete inhibition of plasma human immunodeficiency virus(HIV).Similar to common Graves’disease of patients with HIV negative,the most common symptoms were palpitations and fatigue.One case was complicated with Graves’ophthalmopathy,while one with hyperthyroidic periodic paralysis and ventricular tachycardia.All five cases were treated with methimazole(MMI),among which 4 cases were cured and 1 cases relapsed,who was cured by iodine-131.Conclusions Graves’disease is one of the manifestations of immune reconstitution inflammatory syndrome in patients with AIDS after HAART.It is relatively late onset and occurs after rapid recovery of immune function in patients with advanced immunosuppression.The possibility of Graves’disease should be considered in patients with AIDS who develop euthyroid toxicity symptoms such as fatigue that do not match the recovery of immune function.