7例艾滋病合并肾上腺皮质功能减退症病人临床特点及治疗转归

Clinical characteristics and treatment outcomes of 7 AIDS patients with adrenocortical hypofunction

目的总结艾滋病(AIDS)合并肾上腺皮质功能减退症(AI)病人的临床特点及治疗转归。方法选取收治的7例艾滋病合并肾上腺皮质功能减退症病人的临床资料,对其临床表现、辅助检查、治疗及转归进行回顾性分析。结果5例为原发性AI,2例为继发性AI。男性6例,女性1例,年龄27~68岁。7例病人均有乏力、消瘦、厌食及低钠血症,5例有肌肉及关节疼痛症状,4例血皮质醇低于正常范围,6例有巨细胞病毒感染病史,1例有结核感染病史,1例有肾上腺肿瘤,2例有抗真菌药物使用史,1例有抗结核药物使用史,6例已开始抗病毒治疗,1例糖皮质激素治疗出现不良反应,5例预后良好。结论艾滋病合并AI病人临床表现隐匿,临床医生在管理有合并AI风险的病人时需保持高度的警惕,特别是病人出现一些无法解释的症状时,应考虑AI。

Objective To summarize the clinical characteristics,and treatment outcomes of AIDS patients with adrenocortical hypofunction(AI).Methods The clinical data of 7 cases of AIDS patients with AI were analyzed retrospectively.Results Five cases were primary AI and 2 cases were secondary AI,with 6 males and 1 female aged 27-68 years.All the patients had symptoms of asthenia,emaciation,anorexia and hyponatremia,with 5 cases of the symptoms of muscle and joint pain,4 cases of cortisol lower than the normal range,6 cases with the history of cytomegalovirus infection,1 case with the history of tuberculosis infection and 1 case with adrenal tumor.Two cases had the history of antifungal drug use.One case had the history of anti-tuberculosis drug use.Six cases had started HAART.One case had adverse reactions after glucocorticoid treatment.Five cases had a good prognosis.Conclusion The clinical manifestations of AIDS patients with AI are insidious.Clinicians need to be vigilant in managing the patients at the risk of AI,especially when the patients have unexplained symptoms.