摘要
目的 探讨艾滋病患者几种常见消化道感染性疾病的临床特征及病理组织学改变,提高对艾滋病患者消化道感染性疾病的认识,更好应对艾滋病患者的消化道机会性感染.方法 收集并回顾性分析首都医科大学附属北京地坛医院 2019 年 1 月至2021 年 11 月艾滋病患者消化道内镜活检的病理学阳性标本 35 例,分别用HE染色、组织化学特殊染色、原位杂交、免疫组织化学染色等方法寻找艾滋病患者消化道疾病的病因,查阅文献资料探讨其临床症状、内镜下表现及病理组织学改变及关系.结果 艾滋病患者消化道 CMV阳性者 11 例,临床表现为不同程度的发热、乏力、纳差、腹痛、腹胀,CD4+T淋巴细胞低者(<200 个/μL),内镜及病理黏膜病变轻;阿米巴原虫感染阳性者 13 例,临床症状以发热、腹胀、腹泻为主,CD4+T 淋巴细胞低者,内镜及病理表现重;消化道 MAI感染者 2 例;结核杆菌感染 8 例,均位于下消化道;HSV感染 1 例,消化道黏膜呈现不同程度糜烂、溃疡、息肉、隆起.结论 晚期艾滋病患者因免疫力极度低下,出现的消化道机会性感染更加严重和复杂.提高对消化道机会性感染的临床及病理特点的认识,有助于提高病原学诊断率,使患者得到及时正确的诊断和治疗.
Abstract
Objective To investigate the clinical characteristics and histopathology of several common digestive tract infections in patients with HIV/AIDS,aiming to enhance the understanding of gastrointestinal opportunistic infections in HIV/AIDS patients and better manage them.Methods A retrospective analysis was conducted on 35 positive patholog-ical specimens from gastrointestinal endoscopic biopsies of HIV/AIDS patients at Beijing Ditan Hospital,Capital Medical University,from Jan.2019 to Nov.2021.Methods including HE staining,special histochemical staining,in situ hy-bridization,and immunohistochemistry were employed to identify the causes of gastrointestinal diseases in HIV/AIDS pa-tients.Literature review was conducted to discuss clinical symptoms,endoscopic manifestations,histopathological chan-ges and their relationships.Results Among HIV/AIDS patients,11 cases were positive for CMV in the gastrointestinal tract,clinically presenting with varying degrees of fever,fatigue,poor appetite,abdominal pain,and bloating,with low CD4+T lymphocyte counts(<200 cells/μL)and mild endoscopic and pathological mucosal lesions.Thirteen cases were positive for amoebic parasite infections,with main symptoms of fever,bloating and diarrhea,and low CD4+T lympho-cyte counts,showing severe endoscopic and pathological manifestations.Two cases had gastrointestinal MAI infection.Eight cases were infected with Mycobacterium tuberculosis,all located in the lower gastrointestinal tract.One case had HSV infection,presenting with varying degrees of erosion,ulceration,polyps and protrusions in the gastrointestinal mu-cosa.Conclusion Opportunistic gastrointestinal infections in late-stage HIV/AIDS patients are more severe and com-plex due to severely compromised immune function.Enhancing understanding of the clinical and pathological character-istics of gastrointestinal opportunistic infections can improve the diagnostic rate of pathogens,leading to timely and accu-rate diagnosis and treatment of patients.
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