Joshi M K, Liu H H
CareSouth, Jackson, Tennessee, USA.
AIDS Patient Care STDS. 2000 Oct;14(10):541-8. doi: 10.1089/108729100750018308.
Rhabdomyolysis is a common cause of acute renal failure and may be related to a variety of predisposing factors. This entity has been increasingly recognized in HIV-infected individuals and is an important cause of morbidity and mortality. We present a series of seven HIV-positive patients admitted with rhabdomyolysis over a 5-year period; three developed acute renal failure. Infections and substance abuse were the most common risk factors identified; an average of three predisposing factors was present in each case. All patients showed resolution of creatinine phosphokinase (CPK) elevation and serum creatinine returned to the normal range in the three patients who developed renal insufficiency; however, all patients required prolonged hospitalization and one patient died of sepsis. The pathophysiological mechanisms of muscle injury in our patients are reviewed and their bearing on prognosis discussed. It is concluded that clinicians should have a high index of suspicion for the development of rhabdomyolysis in HIV-infected patients with a combination of noncompliance with medical therapy and/or substance abuse and acute infection. With comprehensive supportive care, the prognosis of acute rhabdomyolysis in this population may be reasonably good.
横纹肌溶解症是急性肾衰竭的常见病因，可能与多种诱发因素有关。在感染人类免疫缺陷病毒（HIV）的个体中，这种病症越来越受到关注，并且是发病和死亡的重要原因。我们报告了在5年期间收治的7例因横纹肌溶解症入院的HIV阳性患者；其中3例发展为急性肾衰竭。感染和药物滥用是最常见的危险因素；每例患者平均存在3个诱发因素。所有患者的肌酸磷酸激酶（CPK）升高均得到缓解，3例出现肾功能不全的患者血清肌酐恢复至正常范围；然而，所有患者均需要延长住院时间，1例患者死于败血症。本文回顾了我们患者肌肉损伤的病理生理机制，并讨论了其对预后的影响。得出的结论是，对于不遵守药物治疗和/或药物滥用且合并急性感染的HIV感染患者，临床医生应高度怀疑其发生横纹肌溶解症。通过全面的支持治疗，该人群急性横纹肌溶解症的预后可能相当良好。
