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中华实验和临床感染病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 79 -83. doi: 10.3877/cma.j.issn.1674-1358.2023.02.002

综述

复方磺胺甲噁唑治疗获得性免疫缺陷综合征合并肺孢子菌肺炎现状及其肝功能损伤机制
王彤彤, 朱春雨, 刘颖楚, 郜桂菊()   
  1. 100069 北京,首都医科大学
    100015 北京,首都医科大学附属北京地坛医院艾滋病中心
  • 收稿日期:2022-09-07 出版日期:2023-04-15
  • 通信作者: 郜桂菊
  • 基金资助:
    "十三五"重大专项课题(No. 2017ZX10202101004); 北京市科委首都特色课题(No. Z171100001017053); 首都医科大学附属北京地坛医院院内科研基金"育苗计划"项目(No. DTYM-202115)

Current situation and mechanism of liver function injury in patients with acquired immunodeficiency syndrome combined with pneumocystis pneumonia treated by Trimethoprim sulfamethoxazole

Tongtong Wang, Chunyu Zhu, Yingchu Liu, Guiju Gao()   

  1. Capital Medical University, Beijing 100069, China
    Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2022-09-07 Published:2023-04-15
  • Corresponding author: Guiju Gao
引用本文:

王彤彤, 朱春雨, 刘颖楚, 郜桂菊. 复方磺胺甲噁唑治疗获得性免疫缺陷综合征合并肺孢子菌肺炎现状及其肝功能损伤机制[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(02): 79-83.

Tongtong Wang, Chunyu Zhu, Yingchu Liu, Guiju Gao. Current situation and mechanism of liver function injury in patients with acquired immunodeficiency syndrome combined with pneumocystis pneumonia treated by Trimethoprim sulfamethoxazole[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(02): 79-83.

肺孢子菌肺炎(PCP)是好发于免疫功能低下及CD4+ T淋巴细胞计数低的获得性免疫缺陷综合征(AIDS)患者的一种危及生命的肺部感染,是AIDS患者最为常见的机会性感染(OIs)之一。复方磺胺甲噁唑(TMP-SMZ)为治疗PCP的一线用药,主要通过干扰叶酸合成以达到杀伤肺孢子菌的作用。但其不良反应较多,如皮疹、药物热、转氨酶升高和血小板减少等,严重时需停药,影响临床治疗和患者预后。我国AIDS患者使用TMP-SMZ引起的肝功能损伤并不罕见,可表现为转氨酶升高和黄疸,甚至急性肝坏死。本文就AIDS合并PCP的流行病学、治疗及TMP-SMZ引起肝功能损伤的机制进行探讨,为临床治疗相关疾病提供诊疗思路。

Pneumocystis pneumonia (PCP) is a life-threatening pulmonary infection that commonly occurs in immunocompromised patients and human immunodeficiency virus (HIV)-infected patients with low CD4+ T cell counts, which is one of the most common opportunistic infections (OIs) in patients with acquired immunodeficiency syndrome (AIDS). For a long time, Trimethoprim sulfamethoxazole (TMP-SMZ) remains the first-line recommended treatment for PCP. It kills pneumocystis by blocking folic acid synthesis. But it has many adverse reactions such as rash, fever, hepatotoxicity, thrombocytopenia and sometimes has to be discontinued, which affects clinical treatment outcome and patient’s prognosis. Hepatotoxicity caused by TMP-SMZ in patients with AIDS in our country is not rare. It can be manifested as elevated hepatic transaminases, jaundice and even acute liver injury. This review describes the epidemiology and treatment of HIV-associated PCP and the pathogenesis of hepatotoxicity caused by trimethoprim-sulfamethoxazole, in order to provide diagnosis and treatment ideas for clinical treatment of related diseases.

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