人类免疫缺陷病毒阳性合并系统性红斑狼疮八例的临床特点分析

Clinical characteristics of eight human immunodeficiency virus positive patients with systemic lupus erythematosus

目的探讨人类免疫缺陷病毒(human immunodeficiency virus,HIV)阳性合并系统性红斑狼疮(systemic lupus erythematosus,SLE)患者的临床特征、诊疗过程及预后。方法回顾性分析2017年8月至2020年1月云南省传染病医院收治的8例HIV阳性合并SLE患者的临床特征、治疗及预后等。结果8例患者均为确诊HIV感染后再诊断合并SLE,均为女性,4例CD4^(+)T淋巴细胞计数>500/μL,2例CD4^(+)T淋巴细胞计数为350~499/μL,2例CD4^(+)T淋巴细胞计数为200~349/μL。病例6临床表现为颜面部蝶形红斑。病例1的血红蛋白为40 g/L,尿隐血(++)。病例2的血红蛋白为76 g/L,血小板计数为2×10^(9)/L,中性粒细胞计数为0.6×10^(9)/L。病例3肺部计算机断层成像检查示双肺弥漫性渗出病灶。病例4和5的24 h尿蛋白分别为2231.6 mg和2761.0 mg,尿隐血均为(++)。病例4总胆红素为70.0μmol/L,丙氨酸转氨酶为49 U/L。病例7总胆红素为129.6μmol/L,丙氨酸转氨酶为56 U/L。病例8肺部计算机断层成像检查示心包腔中等至大量心包积液。7例患者接受了抗病毒治疗和免疫治疗,病情稳定,未复发;其中病例1为难治性系统性红斑狼疮合并自身免疫性溶血性贫血,采用利妥昔单抗联合环磷酰胺治疗后达到临床缓解;病例7为注射药瘾者,放弃治疗后死亡。结论HIV阳性合并SLE的患者临床表现异质性较大,经抗病毒和免疫治疗,一般预后较好;对于难治性SLE合并自身免疫性溶血性贫血的患者,通过积极治疗也可达到临床缓解。

Objective To analyze the clinical characteristics,diagnosis and treatment process,and prognosis of human immunodeficiency virus(HIV)positive patients with systemic lupus erythematosus(SLE).Methods A retrospective study was used to collect and analyze the clinical characteristics,treatment and prognosis of eight HIV-positive patients with SLE treated in Yunnan Provincial Infectious Diseases Hospital from August 2017 to January 2020.Results All of the eight patients were diagnosed with SLE after HIV infection.All of the patients were female.CD4^(+)T lymphocyte counts were>500/μL in four cases,350 to 499/μL in two cases,and 200 to 349/μL in the remaining two cases.Case 6 presented with butterfly erythema on the face.In Case 1,hemoglobin was 40 g/L and urine occult blood was(++).The hemoglobin of Case 2 was 76 g/L,the platelet count was 2×10^(9)/L,and the granulocyte count was 0.6×10^(9)/L.The lung computed tomography(CT)examination of Case 3 showed diffuse exudative lesions in both lungs.The 24 h urinary protein levels of Case 4 and 5 were 2231.6 mg and 2761.0 mg,respectively,and urine occult blood were(++).The total bilirubin of Case 4 was 70.0μmol/L and alanine aminotransferase(ALT)was 49 U/L.The total bilirubin of Case 7 was 129.6μmol/L and ALT was 56 U/L.The lung CT examination of Case 8 showed moderate to massive pericardial effusion in the pericardium.Seven patients received antiviral therapy and immunotherapy,and their conditions were stable without relapse.Case 1 was refractory SLE complicated with autoimmune hemolytic anemia.After treated with rituximab combined with cyclophosphamide the patient achieved clinical remission.Case 7 was injection drug user and died after giving up treatment.Conclusions The clinical characteristics of HIV-positive patients with SLE are heterogeneous,and the prognosis is generally good after antiviral therapy and immunotherapy.For patients with refractory SLE complicated with autoimmune hemolytic anemia,clinical remission can also be achieved through active treatment.