HIV/AIDS合并阿米巴肠病3例临床病理分析  

Amoeba bowel disease in HIV/AIDS patients: a clinicopathological analysis of three cases

作　　者：朱艳培 王欣欣 孟令佳 吕福东 ZHU Yan-pei;WANG Xin-xin;MENG Ling-jia;LV Fu-dong(Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院临床病理中心,北京100069

出　　处：《诊断病理学杂志》2020年第9期665-668,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨HIV/AIDS合并阿米巴肠病患者的临床特点、病理学诊断及鉴别诊断,以提高对HIV/AIDS合并阿米巴肠病的组织学认识。方法回顾性分析3例HIV/AIDS合并阿米巴肠病患者的临床表现和组织学特征,并结合文献探讨其诊断及鉴别诊断。结果 3例患者均为男性,临床表现以腹痛、发热为主。外周血HIV抗体(+),CD4+T淋巴细胞计数均小于参考值下限。电子纤维肠镜检查表现为肠黏膜的多发溃疡及黏膜隆起性病变。病理组织学表现为肠黏膜糜烂及炎性坏死,其内可见圆形或卵圆形的阿米巴滋养体,核相对较小,呈圆形,有的可见核仁,并见滋养体吞噬红细胞现象。结论阿米巴肠病是HIV/AIDS患者不容忽视的机会性感染,与各类以腹泻为表现的肠道炎症性疾病内镜下所见不易区别,病理组织学活检以找到阿米巴滋养体为确诊的主要依据。Objective To explore the clinical characteristics,pathological diagnosis and differential diagnosis of amoeba bowel disease in HIV/AIDS patients,and to improve the histological understanding of HIV/AIDS complicated with amoeba intestinal disease. Methods The clinical manifestations and histological characteristics of 3 patients with HIV/AIDS complicated with amoebic bowel disease treated in our hospital from June 2013 to June 2019 were analyzed retrospectively.The diagnosis and differential diagnosis of HIV/AIDS complicated with amoebic bowel disease were discussed in combination with the literature. Results All the 3 patients were male,and the main clinical manifestations were abdominal pain and fever. The peripheral blood HIV antibody was positive and CD4+ T lymphocyte count was less than the lower limit of the reference value. Electron fiberoptic enterscopy showed multiple ulcerative and mucosal protuberant lesions of the intestinal mucosa. The histological features were characterized by intestinal mucosal erosion and inflammatory necrosis,within which round or oval amoeba trophozoites were seen,the nucleus was relatively small and round,some nucleoli and trophozoite phagocytosis of red blood cells could be seen. Conclusion Amoeba bowel disease is an opportunistic infection that cannot be ignored in HIV/AIDS patients,which is not easily distinguished from various intestinal inflammatory diseases characterized by diarrhea under endoscope. Finding amoeba trophozoites by histolopathological biopsy is the main basis for the diagnosis of amoeba enteropathy,which can be used to find or rule out the cause of HIV/AIDS patients with diarrhea as soon as possible for further treatment.

关 键 词：HIV/AIDS 阿米巴肠病 病理组织学 

分 类 号：R512.91[医药卫生—内科学]