艾滋病贫血.pptVIP

Anemia in human immunodeficiency virus (HIV)–infected patients;贫血;分类： ★急性、慢性 ★红细胞形态（大细胞性、正常细胞性、小细胞低色素性） ★骨髓增生情况： 增生性贫血（溶血性、缺铁性、巨幼贫） 增生低下贫血（再生障碍性贫血） ★病因分类;一、红细胞生成减少 （一）造血干祖细胞异常 ※再生障碍性贫血 ※纯红再障 先天性：Diamond-Black fan 综合征 后天性： 原发---部分患者血清中有自身 EPO或幼红细胞的抗体 继发---药物相关型、感染相关型、 自身免疫病相关型、淋巴细胞增殖 性疾病相关型;※先天性细胞生成异常性贫血 ※造血系统恶性克隆性疾病 （二）造血微环境异常 ※骨髓基质、基质细胞受损 ※造血调节因子水平异常：SCF、IL、GM-CSF、G-CSF、EPO、TPO、TGF、TNF、IFN ※造血原料不足或利用障碍 二、溶血性贫血 三、失血性贫血 ;Background---2000; In February and June of 1998, The Anemia in HIV Working Group, an expert panel of AIDS clinicians from the United States, convened to discuss that： the impact of anemia in patients with HIV infection the available treatment options the practice strategies and future research directions;Anemia is a common complication of HIV infection;Anemia in HIV Infection: Clinical Impactand Evidence-Based Management Strategies;;WHAT CAUSES ANEMIA IN HIV INFECTED PERSONS;Decreased RBC production;抗逆转录病毒药物 -扎西他滨 -齐多夫定 抗病毒药 -更昔洛韦 -膦甲酸钠 -西多福韦 抗真菌药物 -氟胞嘧啶 -两性霉素 抗肺孢子菌药物 -磺胺类药物-甲氧苄啶-乙胺嘧啶-喷他脒 抗肿瘤药物 -环磷酰胺-阿霉素-甲氨蝶呤-紫杉醇-长春碱-脂质体阿霉素-脂质体柔红霉素 免疫反应调节剂 -干扰素-a ;Increased RBC destruction;Ineffective RBC production;WHAT FACTORS ARE ASSOCIATED WITHANEMIA IN HIV-INFECTED PERSONS;Sex--- menstrual blood loss and to the drains on iron stores that occur with pregnancy and delivery Race--- 39% among African American women, 19% among white women, 31% among African American men, and 12% among white men（ presence of inherited hematologic disorders,such as sickle cell disease and thalessemia； Dietary ） ;Zidovudine treatment--- bone marrow suppression (hemoglobin 12 g/dL) in the pre-HAART era (1993–1996), use of zidovudine during the HAART era (1996–2000) was not significantly (hemoglobin 10g/dL) in 41.6% of subjects receivingzidovudine therapy, compared with 34.3% of those not receivingzidovudine (P .01);Worsening H