37例艾滋病患者药物热临床分析

Clinical analysis of drug fever in 37 AIDS patients

目的:探究艾滋病患者发生药物热的临床特征,以期为其药物热的诊疗提供参考。方法:回顾性收集发生药物热的艾滋病患者基本情况、诊疗经过、药物热发热特点、致热药物等,将感染性发热与药物热比较,总结药物热临床特征。结果:(1)共收集发生药物热的艾滋病患者37例,其入院时均因合并其他感染性疾病有不同程度发热,体温(39.2±0.87)℃,抗感染治疗后体温均恢复正常,感染性发热病程(17.72±12.98) d。(2)β-内酰胺类抗生素、美罗培南、异烟肼及利福霉素类抗结核药物、复方磺胺甲基异■唑均可导致药物热,以β-内酰胺类最常见(51%),其次是利福霉素类(30%)。(3)与感染性发热比较,药物热高热者更多(70.3%),以弛张热、稽留热为主,而感染性发热高热者43.2%,以不规则热更常见(均P<0.05);药物热时血白细胞数及中性粒细胞比例均明显低于感染性发热,而嗜酸性粒细胞比例明显高于感染性发热患者(均P<0.05)。结论:药物热是艾滋病患者发热原因中并不少见的原因,β-内酰胺类抗生素及利福霉素类抗结核药物最常见。发热的热型、热度、用药情况及实验室检查结果可作为药物热鉴别诊断要点。

OBJECTIVE To explore the clinical characteristics of drug fever in AIDS patients in order to provide reference for the diagnosis and treatment of drug fever.METHODS The basic information,diagnosis and treatment process,characteristics of drug fever and fever-causing drugs were collected retrospectively,and the clinical features of the drug fever were summarized.RESULTS(1)A total of 37 AIDS patients with drug fever were collected.They were hospitalized with different degrees of fever due to other infectious diseases,and the body temperature was(39.2±0.87)℃.After anti-infection treatment,the body temperature returned to normal,and the course of infectious fever was(17.72+12.98)days.(2)β-lactam antibiotics,meropenem,isoniazid and rifamycins,and trimethoprim-sulfamethoxazole all cause drug fever,withβ-lactams being the most common drug(51%),followed by rifamycins(30%).(3)Compared with infectious fever,a majority of patients(70.3%)had drug fever and high fever,which were mainly remittent fever and missed fever,while 43.2%had infectious fever and high fever,which were mainly irregular fever(both P<0.05).The number of leukocytes and the proportion of neutrophils in the blood of patients with drug fever were significantly lower than those of patients with infective fever,while the proportion of eosinophils was significantly higher than those of patients with infective fever(both P<0.05).CONCLUSION Drug-induced fever is a common cause of fever in AIDS patients.The fever type,temperature,medication and laboratory test results can be used as the main points of differential diagnosis of drug fever.