中国98例人类免疫缺陷病毒感染患者的独特风湿表现。

Distinctive rheumatic manifestations in 98 patients with human immunodeficiency virus infection in China.

作者信息

Zhang Xuan, Li Hongbin, Li Taisheng, Zhang Fengchun, Han Yang

机构信息

Department of Immunology and Rheumatology, Peking Union Medical College Hospital, Beijing, China.

出版信息

J Rheumatol. 2007 Aug;34(8):1760-4. Epub 2007 Jul 15.

PMID:17659750

Abstract

OBJECTIVE

To analyze the spectrum and risk factors of rheumatic manifestations in patients with human immunodeficiency virus (HIV) infection.

METHODS

Ninety-eight consecutive inpatients with HIV infection admitted to Peking Union Medical College Hospital from 1999 to 2006 were studied. Demographic data, routes of transmission, clinical features, and laboratory findings were collected and a database was established. Laboratory studies included blood CD3+, CD4+, CD8+, CD19+, CD16+CD3+, CD4+CD28+, CD8+CD28+, HLA- DR+CD8+, and CD8+CD38+ lymphocyte counts, and antinuclear antibody tests. Hepatitis C virus (HCV) infection was also investigated in each patient. Risk factors for the rheumatic manifestations of HIV infection were assessed by logistic regression analysis.

RESULTS

Rheumatic manifestations were found in 53 (54.08%) HIV patients. Vasculitis was the most common finding (20 cases; 20.41%), including 15 cases of Behçet-like disease, 2 cases each of Henoch-Schönlein purpura and digital gangrene, and one case of central nervous system vasculitis. Other common rheumatic manifestations included Sjögren-like syndrome/diffuse infiltrative lymphocytosis syndrome (DILS; 11 cases; 11.22%), lupus-like syndrome (10 cases; 10.20%), of which 5 cases had renal involvement, and myositis (8 cases; 8.16%) including one case of zidovudine-induced myositis. No case of spondyloarthropathy was observed. Logistic regression analysis showed that Centers for Disease Control CD4+ T cell staging, erythrocyte sedimentation rate, and HCV infection were risk factors for HIV patients to develop rheumatic manifestations [p = 0.01, odds ratio (OR) = 31.80; p = 0.02, OR = 2.93; p = 0.01, OR = 17.47, respectively].

CONCLUSION

Rheumatic disorders such as vasculitis, Sjögren-like syndrome/DILS, lupus-like syndrome, and myositis were common in Chinese patients with HIV, while articular disorders were rare. CD4+ T cell depletion and HCV coinfection may predispose patients with HIV to develop rheumatic manifestations.

摘要

目的

分析人类免疫缺陷病毒（HIV）感染患者风湿性表现的谱型及危险因素。

方法

对1999年至2006年北京协和医院收治的98例连续住院的HIV感染患者进行研究。收集人口统计学数据、传播途径、临床特征及实验室检查结果并建立数据库。实验室检查包括血液CD3 +、CD4 +、CD8 +、CD19 +、CD16 + CD3 +、CD4 + CD28 +、CD8 + CD28 +、HLA - DR + CD8 +及CD8 + CD38 +淋巴细胞计数，以及抗核抗体检测。同时对每位患者进行丙型肝炎病毒（HCV）感染调查。通过逻辑回归分析评估HIV感染患者风湿性表现的危险因素。

结果

53例（54.08%）HIV患者出现风湿性表现。血管炎最为常见（20例；20.41%），包括15例白塞氏病样疾病、2例过敏性紫癜和指端坏疽各2例，以及1例中枢神经系统血管炎。其他常见的风湿性表现包括干燥综合征样综合征/弥漫性浸润性淋巴细胞增多综合征（DILS；11例；11.22%）、狼疮样综合征（10例；10.20%），其中5例有肾脏受累，以及肌炎（8例；8.16%），包括1例齐多夫定诱导的肌炎。未观察到脊柱关节病病例。逻辑回归分析显示，疾病控制中心CD4 + T细胞分期、红细胞沉降率及HCV感染是HIV患者发生风湿性表现的危险因素[分别为p = 0.01，比值比（OR）= 31.80；p = 0.02，OR = 2.93；p = 0.01，OR = 17.47]。