艾滋病合并重度血小板减少临床特征分析

Clinical feature analysis of AIDS complicated with severe thrombocytopenia

目的报告艾滋病合并重度血小板减少患者3例,并结合文献搜索讨论其有效治疗方法,为进一步提高临床诊治提供经验。方法回顾分析3例艾滋病合并重度血小板减少患者的临床资料,讨论其有效治疗方法。结果3例患者临床表现主要为全身皮肤瘀点、瘀斑,其中2例伴发黏膜出血。3例患者中2例在出现血小板减少时未启动抗病毒治疗,另1例患者已行抗病毒治疗2年,但CD4+T淋巴细胞计数仍<200个/μl。3例患者均使用甲泼尼松龙联合强效抗病毒治疗,后续贯泼尼松龙巩固治疗。1例患者激素治疗无效,行脾切除术。经过治疗3例患者血小板均逐渐恢复并出院。结论HIV相关性血小板减少的发生可能与HIV在体内持续活跃复制有关,早期以强效抗病毒治疗联合激素冲击疗法为首选方案,可明显改善患者生活质量及结局。

Objective To report 3 patients of AIDS complicated with severe thrombocytopenia,discuss the effective treatment based on the literature retrieval,and provide experience for further improvement of clinical diagnosis and treatment.Methods Clinical data of AIDS complicated with severe thrombocytopenia were analyzed retrospectively to discuss the effective treatment.Results The main clinical manifestation of 3 patients included petechiae or suggillation in the systemic skin,and was associated mucosal hemorrhage in 2 cases.Two of 3 patients did not initiate antiviral therapy in the presence of thrombocytopenia,while 1 of 3 patients had been on antiviral therapy for 2 years,but CD4+T lymphocytes were still less than 200 cells/μl.All 3 patients were treated with methylprednisolone combined with strong antiviral therapy,followed by prednisolone consolidation therapy.One patient did not respond to hormone therapy and underwent splenectomy.After treatment,the platelets of all 3 patients recovered gradually,and they were discharged.Conclusions The occurrence of primary HIV-associated thrombocytopenia may be related to the continuous active replication of HIV in vivo.Early strong antiviral therapy combined with hormone shock therapy is the preferred regimen,which can significantly improve the patient’s quality of life and outcome.