CAJ | 학술논문

目的总结艾滋病(即获得性免疫缺陷综合征,acquired immune deficiency syndrome,AIDS)患者咽部溃疡的特点.方法分析2008年8月至2013年6月收治的20例咽部溃疡的艾滋病患者临床诊断和治疗资料,其中以咽痛伴咽部巨大溃疡长期不愈为艾滋病首发症状者9例.结果 20例艾滋病患者咽痛剧烈、进食困难、消瘦明显,常规治疗效果不佳,病程迁延(7 d～8个月).咽部溃疡位于腭弓10例,扁桃体3例,咽侧壁l例,会厌3例,梨状窝2例,咽喉多部位溃疡1例.重型(巨型)阿弗他溃疡(major aphthous ulcer) 14例,真菌性溃疡2例,带状疱疹1例,药疹继发溃疡1例,淋巴瘤2例;CD4+T淋巴细胞2～252个/μl,平均48个/μl,T淋巴细胞CD4 +/CD8+比值为0～0.73,平均0.13.给予高效抗反转录病毒治疗(highly active antiretroviral therapy)和免疫调节治疗,止痛,抗感染,抗真菌及营养支持治疗.9例复查T细胞亚群,其中7例溃疡好转并愈合,治疗2个月时,CD4+T淋巴细胞计数提高到22 ～ 225个/μl,平均99个/μl;T淋巴细胞CD4 +/CD8+比值提高到0.04～0.77,平均0.20.治疗2周～3个月后溃疡愈合13例;失访1例,死亡6例(心源性猝死、中枢神经系统感染、消化道出血、深部真菌感染各1例,淋巴瘤2例).结论艾滋病患者咽部溃疡症状重,病程长,常合并多种机会性感染及肿瘤,在局部治疗的同时,更要加强高效抗反转录病毒治疗和全身综合治疗.咽部溃疡长期不愈,合并发热、腹泻等症状,尤其是有明确输血史、注射吸毒史或不洁性行为史者,应高度警惕HIV感染的可能.
목적 총결애자병(즉획득성면역결함종합정,acquired immune deficiency syndrome,AIDS)환자인부궤양적특점.방법 분석2008년8월지2013년6월수치적20례인부궤양적애자병환자림상진단화치료자료,기중이인통반인부거대궤양장기불유위애자병수발증상자9례.결과 20례애자병환자인통극렬、진식곤난、소수명현,상규치료효과불가,병정천연(7 d～8개월).인부궤양위우악궁10례,편도체3례,인측벽l례,회염3례,리상와2례,인후다부위궤양1례.중형(거형)아불타궤양(major aphthous ulcer) 14례,진균성궤양2례,대상포진1례,약진계발궤양1례,림파류2례;CD4+T림파세포2～252개/μl,평균48개/μl,T림파세포CD4 +/CD8+비치위0～0.73,평균0.13.급여고효항반전록병독치료(highly active antiretroviral therapy)화면역조절치료,지통,항감염,항진균급영양지지치료.9례복사T세포아군,기중7례궤양호전병유합,치료2개월시,CD4+T림파세포계수제고도22 ～ 225개/μl,평균99개/μl;T림파세포CD4 +/CD8+비치제고도0.04～0.77,평균0.20.치료2주～3개월후궤양유합13례;실방1례,사망6례(심원성졸사、중추신경계통감염、소화도출혈、심부진균감염각1례,림파류2례).결론 애자병환자인부궤양증상중,병정장,상합병다충궤회성감염급종류,재국부치료적동시,경요가강고효항반전록병독치료화전신종합치료.인부궤양장기불유,합병발열、복사등증상,우기시유명학수혈사、주사흡독사혹불길성행위사자,응고도경척HIV감염적가능.
Objective To understand the high incidence of pharyngeal ulcer in patients with acquired immune deficiency syndrome (AIDS).By analyzing the clinical features in AIDS patients with pharyngeal ulcer,this study provided reference for clinicians.Methods Twenty AIDS patients with pharyngeal ulcer were retrospectively analysed to explore its clinical features and mechanism,and to explore the feasible therapeutic methods.Results The patients generally had severe sore throat and dysphagia for 7 days to 8 months,resulting in significant weight loss.Common therapeutical method does not work.The ulcers developed mainly at vestibule of pharynx (10 cases),tonsil (3 cases),epiglottis (3 cases) and pyriform sinus (2 cases).Ulcer types included major aphthous ulcer (MaAU,14 cases),fungal ulcer (2 cases),herpes zoster (1 case),ulcer secondary to drug eruption(1 case),and lymphoma(2 cases).The disease course was long with CD4 + T lymphocytes decreased significantly.Treatment was given with highly active antiretroviral therapy (HARRT),regulation of immune function,analgesic,anti-inflammatory and anti fungal.Treatment lasted from 2 weeks to 3 months,ulcer healed in 13 cases; 1 patient lost to follow-up,6 patients dead.Conclusions The manifestation of pharyngeal ulcer in AIDS patients has its particularity.It is often associated with a variety of opportunistic infection and tumors.Local treatment is preferred.HAART therapy and systemic comprehensive treatment play more important and effective role.Pharyngeal ulcer persists for a long time,complicated with fever,diarrhea and other symptoms.The history of blood transfusion,injection drug use or unsafe sexual behavior may predict HIV infection.