艾滋病患者咽部溃疡性病变特点分析  

Pharyngeal ulcer in patients with acquired immune deficiency syndrome

作　　者：房高丽[1] 张罗[2] 王成硕[2] 肖江[3] 付茜[4] 赵红心[3] 

机构地区：[1]首都医科大学附属北京地坛医院耳鼻咽喉科,100015 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科北京市耳鼻咽喉科研究所 [3]首都医科大学附属北京地坛医院感染中心,100015 [4]首都医科大学附属北京地坛医院口腔科,100015

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第2期125-130,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：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.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.

关 键 词：获得性免疫缺陷综合征 咽疾病 口腔溃疡 

分 类 号：R512.91[医药卫生—内科学]