鼻-鼻窦病变合并人类免疫缺陷病毒感染治疗分析  

Analysis of Treatment of Rhino- sinus Lesion Combined With HIV Infection

作　　者：鲍诗平[1] 刘勇刚[1] 张伟[1] 焦楠[1] 江玲燕[1] 张淼[1] 

机构地区：[1]首都医科大学附属北京佑安医院耳鼻咽喉头颈外科,北京市100069

出　　处：《中国全科医学》2015年第36期4483-4486,共4页Chinese General Practice

基　　金：佑安肝病艾滋病基金资助项目(BJYAH-2011-006);北京市艾滋病临床数据库和样本资源库建设(D13110700530000);北京市乙型肝炎临床数据和样本资料库建设(D131100005313004)

摘　　要：目的初步探讨鼻-鼻窦病变合并人类免疫缺陷病毒(HIV)感染的临床特点,分析鼻-鼻窦病变合并HIV感染患者的治疗方法。方法选取2010年4月—2014年10月首都医科大学附属北京佑安医院耳鼻咽喉头颈外科收治的符合纳入与排除标准的鼻-鼻窦病变合并HIV感染患者20例为研究对象。收集患者的一般资料〔包括患者性别、年龄、病程、治疗前CD_4^+T淋巴细胞计数、疾病种类(慢性鼻炎7例、慢性鼻-鼻窦炎5例、鼻腔鳞癌2例、鼻出血2例、过敏性鼻炎2例、咽囊炎1例、鼻腔血管瘤1例)及临床治疗方案〕和治疗前、治疗后2周、治疗后1个月视觉模拟量表(VAS)评分。结果慢性鼻炎、过敏性鼻炎患者病程1周~3年,治疗前CD_4^+T淋巴细胞计数7~675个/μl,治疗前VAS评分(25.6±5.2)分。主诉鼻塞、嗅觉减退、头痛等慢性鼻炎症状的患者予以等渗鼻冲洗和/或鼻喷糖皮质激素治疗;主诉鼻塞、鼻涕伴鼻痒等过敏性鼻炎症状的患者予以高渗鼻冲洗+鼻喷糖皮质激素,加口服抗过敏药物治疗。治疗后2周VAS评分(11.2±3.2)分,治疗后1个月VAS评分(7.2±3.6)分。慢性鼻-鼻窦炎患者病程1~3个月,治疗前CD_4^+T淋巴细胞计数186~537个/μl,治疗前VAS评分(35.2±4.4)分。其中2例行保守治疗,包括鼻喷糖皮质激素、鼻冲洗和口服黏液促排剂、抗生素治疗;3例采取标准的功能性内镜鼻窦手术,术后辅助药物综合性治疗。治疗后2周VAS评分(24.0±2.8)分,治疗后1个月VAS评分(16.8±8.8)分。鼻腔鳞癌患者病程分别为1个月、7个月,治疗前CD_4^+T淋巴细胞计数分别为252个/μl、797个/μl,治疗前VAS评分均为40.0分。均予以活检确诊后,1例采取内镜下鼻腔鳞癌根治术,另1例伴发颈部淋巴结转移、骨转移行化疗。治疗后2周VAS评分均为32.0分,治疗后1个月VAS评分分别为12.0分、32.0分。鼻出血患者病程均为1 d,治疗前CD_4^+T淋巴细胞计数分别为7个/μl、196个/Objective To investigate the clinical features and treatment methods of rhino- sinus lesion combined with HIV infection. Methods Enrolled 20 patients of rhino- sinus lesion combined with HIV infection who received treatment in the Department of Otorhinolaryngology Head and Neck of Beijing Youan Hospital, Capital Medical University from April 2010 to October 2014. The general data of patients were collected,including gender,age,duration of disease,CD_4~＋T cell count before treatment,disease categories（ 7 cases of chronic rhinitis,5 cases of chronic rhino- sinus disease,2 cases of nasal squamous cancer,2 cases of nosebleed,2 cases of anaphylactic rhinitis,1 case of pharyngeal bursitis and 1 case of nasal hemangioma）and clinical treatment methods and VAS score before treatment,two weeks after treatment and one month after treatment. Results For patients with chronic rhinitis and anaphylactic rhinitis,the duration of disease lasted for one week to three years; before treatment,the CD_4~＋T cell count was 7- 675 / μl,and the VAS score was（ 25. 6 ± 5. 2）; the patients who had major complaints of nasal congestion,olfaction problem,headache and other symptoms of chronic rhinitis were given permeating nasal irrigation and / or glucocorticoid treatment by nasal spray; patients who had major complaints of nasal congestion,nasal mucus combined with rhinocnesmus and other symptoms of allergic rhinitis were given high- degree permeating nasal irrigation plus corticosteroids by nasal spray as well as oral administration of antiallergic drug; the VAS score was（ 11. 2 ± 3. 2） two weeks after treatment and was（ 7. 2 ± 3. 6） one month after treatment. For patients with chronic rhinitis and rhinosinusitis,the duration of disease lasted for one to three months; before treatment,the CD_4~＋T cell count was 186 ~ 537 / μl,and the VAS score was（ 35. 2 ± 4. 4）; 2patients were administrated with conservative treatment methods including glucocorticoid by nasal spray, nasal irrigation,chelating agents for oral

关 键 词：鼻疾病 鼻窦疾病 HIV 治疗 

分 类 号：R765[医药卫生—耳鼻咽喉科]