以血小板减少为首发症状的HIV感染及艾滋病9例报告

Analysis of HIV/AIDS Patients Presenting with Thrombocytopenia:Report of 9 Cases

目的探讨以血小板减少为主要表现的人类免疫缺陷病毒(human immune deficiency virus,HIV)/获得性免疫缺陷综合征(aquired immunodeficiency symdrome,AIDS)患者的血液学特点,避免误诊漏诊。方法回顾性分析因血小板减少为首发表现收住血液科的9例HIV/AIDS患者的临床表现及血细胞、血清蛋白、T淋巴细胞亚群及骨髓细胞学表现。结果 9例患者中,3例诊断为HIV感染急性期,6例诊断为艾滋病期。4例有皮肤黏膜出血表现,2例伴活动性肺结核。血小板单系减少6例,其中重度减少3例,全血细胞减少3例。骨髓细胞学检查:8例增生活跃或明显活跃,1例增生减低;9例均存在巨核细胞成熟障碍,其中巨核细胞数量增多5例,正常及减少各2例。血生化检查显示8例存在白蛋白/球蛋白比值低于正常;在已行T淋巴细胞亚群分析的7例患者中,4例CD4^+/CD8^+比值低于正常。结论伴血小板减少的HIV/AIDS患者骨髓细胞学特点与原发免疫性血小板减少症(idiopathic thrombocytopenic purpura,ITP)类似,对不明原因血小板减少或疑似原发性ITP的患者应常规行HIV筛查。

Objective To explore the hematological characteristics of human immunodeficiency virus(HIV)/acquired immunodeficiency symdrome(AIDS)patients with thrombocytopenia as the initial manifestation,and avoid misdiagnosis and missed diagnosis.Methods The clinical manifestations,blood cells,serum proteins,T-lymphocyte subsets and bone marrow of 9 HIV/AIDS patients admitted to the hematology department due to thrombocytopenia as the initial manifestation were retrospectively analyzed.Results Of the 9 patients,3 were diagnosed as acute HIV infection and 6 as the AIDS stage.Four cases had skin mucosal bleeding,and 2 cases had active pulmonary tuberculosis.Thrombocytopenia was found in 6 cases,including 3 cases of severe thrombocytopenia and 3 cases of pancytopenia.Bone marrow cytology showed 8 cases with hypercellular,1 case with hypocellular.All 9 cases were megakaryocyte dysmaturity,including 5 cases of megakaryocytes increased,2 cases of normal and 2 cases decreased.Blood biochemical examination showed that the albumin/globulin ratio was lower than normal in 8 cases.Of the 7 patients who had undergone T lymphocyte subpopulation analysis,4 had lower CD4^+/CD8^+ratios than normal.Conclusion The bone marrow features of HIV/AIDS patients with thrombocytopenia are similar to those with idiopathic thrombocytopenic purpura(ITP).It is necessary to screen HIV for the patients presenting with unidentified thrombocytopenia or suspected primary ITP.