Wananukul Siriwan, Deekajorndech Tawatchai, Panchareon Chitsanu, Thisyakorn Usa
Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand.
Pediatr Dermatol. 2003 Jul-Aug;20(4):289-94. doi: 10.1046/j.1525-1470.2003.20401.x.
The normal value of the absolute CD4-positive T-lymphocyte count is relatively high in normal infants and declines steadily until 6 years of age, whereas the CD4 percentage of the total lymphocyte count is constant. The immunologic categories according to the 1994 revised pediatric human immunodeficiency virus (HIV) classification, based on CD4-positive percentage of the total lymphocyte count, is classified into three categories: no evidence of suppression (> or =25%), moderate suppression (15-24%), and severe suppression (1-14%). Our objective was to determine the prevalence of mucocutaneous findings in pediatric acquired immunodeficiency syndrome (AIDS) related to the degree of immunosuppression. We prospectively examined 120 children less than 13 years of age who were born to HIV-seropositive women and developed definite HIV infection. The prevalence of mucocutaneous findings in those children who had severe, moderate, and no evidence of immunosuppression were 62%, 43%, and 20%, respectively. The mucocutaneous findings in patients in the moderate and severe suppression groups were significantly more common than in patients without evidence of immunosuppression (p < 0.001). In the moderate immunosuppression group, 11% had two mucocutaneous findings while 21% in the severe immunosuppression group had two or more mucocutaneous findings. The most common mucocutaneous finding was oral candidiasis (33%), which had a mean corresponding CD4 percentage of the total lymphocyte count of 11.3%. Herpes zoster was found in 6% of the patients (mean CD4 percentage of the total lymphocyte count = 13.5%). Chronic herpes simplex virus (HSV) stomatitis was found in 3% of the patients (mean CD4 percentage of the total lymphocyte count = 3%). Mucocutaneous manifestations are common in pediatric AIDS. The majority of these findings have an infectious etiology. The prevalence increases as the CD4-positive percentage of the total lymphocyte count decreases. More than one mucocutaneous finding can be found at the same time in patients with moderate or severe immunosuppression.
正常婴儿的CD4阳性T淋巴细胞绝对计数正常值相对较高，并在6岁前稳步下降，而CD4占总淋巴细胞计数的百分比则保持恒定。根据1994年修订的儿科人类免疫缺陷病毒（HIV）分类，基于CD4阳性占总淋巴细胞计数的百分比，免疫类别分为三类：无免疫抑制证据（≥25%）、中度免疫抑制（15% - 24%）和重度免疫抑制（1% - 14%）。我们的目的是确定与免疫抑制程度相关的儿童获得性免疫缺陷综合征（AIDS）中皮肤黏膜表现的患病率。我们前瞻性地检查了120名13岁以下、出生于HIV血清阳性女性且确诊感染HIV的儿童。在那些有重度、中度和无免疫抑制证据的儿童中，皮肤黏膜表现的患病率分别为62%、43%和20%。中度和重度免疫抑制组患者的皮肤黏膜表现明显比无免疫抑制证据的患者更常见（p < 0.001）。在中度免疫抑制组中，11%有两种皮肤黏膜表现，而在重度免疫抑制组中，21%有两种或更多种皮肤黏膜表现。最常见的皮肤黏膜表现是口腔念珠菌病（33%），其对应的CD4占总淋巴细胞计数的平均百分比为11.3%。6%的患者出现带状疱疹（CD4占总淋巴细胞计数的平均百分比 = 13.5%）。3%的患者出现慢性单纯疱疹病毒（HSV）口腔炎（CD4占总淋巴细胞计数的平均百分比 = 3%）。皮肤黏膜表现在儿童AIDS中很常见。这些表现大多有感染性病因。患病率随着CD4阳性占总淋巴细胞计数百分比的降低而增加。在中度或重度免疫抑制的患者中可同时发现不止一种皮肤黏膜表现。
