认识免疫重建炎症综合征-培训课件.pptVIP

认识免疫重建炎症综合征 安徽医科大学第二附属医院 孙昀 2015.10.31 安徽省医学会重症医学分会第十二次年会 A 35-year-old male with an 8-year history of AIDS presented with a 3-day history of recurrent frontal headaches, subjective fever and alter edmental status. He had a history of non-adherence to medications, but he had resumed antiretroviral drugs for about 10 weeks. Four weeks prior to presentation to our hospital, he had been diagnosed with cryptococcal meningitis (CM) in an outside hospital and had received a 7 day course of intravenous amphotericin B (lipid complex preparation). This was discontinued due to progressive acute kidney injury and he was subsequently placed on high dose (800 mg) oral fluconazole (FLU) daily. Case Report Infectious Disease Reports 2014; volume 6:5576 Case Report Infectious Disease Reports 2014; volume 6:5576 Case Report He was readmitted to the hospital 5 weeks later with recurrent headaches and fevers. MRI of his brain showed no change. Infectious Disease Reports 2014; volume 6:5576 HIV infection is characterized by a gradual reduction in the counts of CD4+ lymphocytes 发现 命名 起初： 免疫修复疾病 (im une reeonstitutiodisease，IRD) 免疫重建病 (immune reconstitution syndrome，IRS) 鉴于宿主的炎性反应在发病中的重要作用, DeSimone 等首次提出免疫重建炎性综合征。 (immune reconstitution inflammation syndrome，IRIS) 分枝杆菌引起的淋巴结病、结核病的异常表现 进展性多灶性脑白质病的恶化 耶氏肺孢子菌肺炎 弓形虫病的复发 巨细胞病毒性视网膜炎 病毒性肝炎…… 有些则可能表现为自身免疫性疾病 临床表现 根据涉及的感染性或非感染性因子的不同而不同 IRIS which may manifest as a newly identified opportunistic infection (OI) in previously asymptomatic individuals (unmasking IRIS) or with paradoxical clinical worsening of a known OI (paradoxical IRIS). IRIS的危害 部分患者不能耐受现有的治疗或对ART药物的作用产生怀疑自行停止ART ； 服药的依从性降低，导致诱发HIV耐药变异的产生与传播，影响ART的远期治疗效果和未来治疗的选择； 增加住院率，降低患者生活质量，提高艾滋病防治工作成本； IRIS的表现常被误判为抗OI病原体治疗无效所引起的一系列表现，导致对其治疗方案的不适当调整。 少数患者因IRIS死亡 ； 影响患者的远期免疫功能重建，研究表明部分发生IRIS的患者，ART 3-4年后CD 细胞的恢复仍受到影响 。 Int J Infect Dis，2011;15:e408-e14. Med Mycol Case Rep，2014;5:16-9. Curr Infect Dis Rep 2013;15:583-93. 艾滋病患者在接受ART后6个月内IRIS的发病率： 欧美发达国家为10％ ～15％。 资源有限的发展中国家为2