50例HIV感染者大肠息肉内镜下表现及病理类型的相关分析  

Correlation analysis of endoscopic presentations and pathological types of colorectal polyps in 50 HIV⁃infected patients

作　　者：郑会聪 李凌华[1] 郑啼婴 许飞龙 肖艳华[1] 罗红彬[1] 胡中伟[1] Zheng Huicong;Li Linghua;Zheng Tiying;Xu Feilong;Xiao Yanhua;Luo Hongbin;Hu Zhongwei(Guangzhou Eighth People’s Hospital Affiliated to Guangzhou Medical University,Guangzhou 510515,China)

机构地区：[1]广州医科大学附属市八医院,广东广州510515

出　　处：《广州医科大学学报》2021年第6期13-17,共5页Academic Journal of Guangzhou Medical University

基　　金：广州市科技计划项目(202002020005)。

摘　　要：目的:探讨HIV感染者大肠息肉内镜表现特点及病理类型。方法:回顾性收集从2015年至2020年间广州医科大学附属市八医院住院行肠镜下息肉切除的HIV感染者,共50例,为观察组;同期于本院消化内科住院行息肉切除的非HIV感染者50例,为对照组;收集观察组和对照组患者基本资料(包括性别、年龄、教育程度、BMI、有无嗜酒嗜烟史等)、大肠息肉内镜下表现(单发或者多发、息肉位置、息肉直径、息肉JNET分型、有无合并炎症表现等)以及息肉病理类型(腺瘤性、增生性、炎性),并对观察组及对照组进行总结及对照分析。根据患者外周血CD4+T淋巴细胞数不同将观察组分为2组,CD4+T淋巴细胞计数<200个/mm^(3)为A组,CD4 T淋巴细胞计数≧200个/mm3为B组,将两组间大肠黏膜是否合并炎症改变(糜烂/溃疡)、息肉病理类型进行对比,再观察比较A组和B组间肠道机会性感染情况。结果:观察组与对照组在性别、年龄、教育程度、BMI、是否饮酒、是否嗜烟、息肉数量(单发或多发)、息肉平均直径、息肉部位、息肉JNET分型等方面对比差异无统计学意义(P>0.05);观察组与对照组在大肠粘膜是否合并炎症表现(糜烂/溃疡)、息肉病理分型(腺瘤性、增生性、炎性)等方面对比差异有统计学意义(P<0.05);观察组A组与B组相比,大肠黏膜更易合并炎症改变(P<0.05);观察组A组、B组和对照组3组间息肉病理类型进行对比,结果显示随着外周血CD4+T淋巴细胞的升高,腺瘤性息肉比例上升,增生性息肉和炎性息肉比例下降。观察组A组与B组相比,A组更容易出现肠道机会性感染,其中以马尔尼菲青霉菌最为常见。结论:与非HIV感染者相比,HIV感染者更容易出现炎性息肉和增生性息肉,且随着外周血CD4+T淋巴细胞的降低,在大肠黏膜出现慢性炎症、机会性感染的背景下,这种趋势更加明显,需要密切关注其发展为恶性肿瘤的可能�Objective:To investigate the endoscopic presentations and pathological types of colorectal polyps in HIV⁃infected patients.Methods:A total of 50 HIV⁃infected patients who underwent colonoscopic polypectomy in Guangzhou Eighth People’s Hospital Affiliated to Guangzhou Medical University between 2015 and 2020 were retrospectively included as the study group.A contemporary cohort of 50 non⁃HIV infected patients who underwent polypectomy in our Department of Gastroenterology were included as the control group.The patients in the study group and control group were reviewed and compared for data on demography(including gender,age,education,BMI,history of alcohol and tobacco use),endoscopic presentations of colorectal polyps(including single/multiple lesion,site,diameter,JNET classification,inflammatory signs)and pathological types of polyps(adenomatous,hyperplastic,inflammatory).The study group were further divided into two sub⁃groups according to peripheral CD4+T⁃lymphocyte counts:group A(<200/mm^(3))and group B(≥200/mm^(3)).The two sub⁃groups were compared for concomitant inflammatory changes(erosions/ulcers)of colorectal mucosa,pathological types of polyps,as well as opportunistic intestinal infections.Results:There were no significant differences between the study group and the control group in gender,age,education,BMI,alcohol and tobacco use,number of lesions(single or multiple),mean diameter,sites,and JNET classification of the polyps(P>0.05).However,the study group and the control group differed statistically in concomitant inflammation of the colorectal mucosa(erosion/ulcer)and the pathological type of polyps(adenomatous,proliferative,inflammatory)(P<0.05).Compared with group B,group A group was more likely to have inflammatory changes in colorectal mucosa(P<0.05).Comparison on pathological types of polyps among the group A,group B and the control group showed that with the increase of peripheral blood CD4+T lymphocytes,the proportion of adenomatous polyps tended to increase,and that of hyperpla

关 键 词：HIV感染 大肠息肉 病理分型 结肠镜 

分 类 号：R574.6[医药卫生—消化系统]