乙型肝炎肝硬化并发自发性细菌性腹膜炎患者血清白蛋白和肝纤维化指标的变化

目的 分析乙型肝炎肝硬化并发SBP患者血清肝纤维化指标及白蛋白水平的变化。方法 在我院2013年1月~2015年6月收治的31例乙型肝炎肝硬化并发自发性细菌性腹膜炎（SBP）患者和同期住院的31例乙型肝炎肝硬化未发生SBP患者,采用放射免疫法检测纤维化指标。结果 SBP组血清PCⅢ、Ⅳ-C、LN和HA水平分别为307.4±20.2μg/L、230.6±20.3μg/L、251.3±16.3μg/L、472.6±22.6μg/L,均显著高于非SBP组（269.8±16.5μg/L、181.6±17.9μg/L、215.6±13.3μg/L、436.1±20.3μg/L （均P<0.05）;SBP组血清和腹水ALB水平分别为23.3±2.2 g/L和10.0±1.3g/L,均显著低于非SBP组（28.9±2.7 g/L和15.9±1.5 g/L（均P<0.05）;SBP患者血清PCⅢ、Ⅳ-C、LN和HA水平均与ALB呈负相关（均P<0.05）。结论 乙型肝炎肝硬化患者并发SBP时可能影响血清肝纤维化指标水平。     

拉米夫定和阿德福韦酯联合治疗乙型肝炎肝硬化患者疗效分析

目的 分析拉米夫定和阿德福韦酯联合治疗乙型肝炎肝硬化患者的疗效。方法 2012年1月~2014年12月我院消化科诊治的136例乙型肝炎肝硬化患者,将其分为两组,给予对照组常规护肝治疗,给予观察组拉米夫定和阿德福韦酯联合治疗。采用RT-PCR法检测血清HBV DNA水平,使用全自动生化分析仪检测血生化指标,使用全自动血细胞分析仪检测血常规,使用C3510凝血分析仪检测凝血功能指标。结果 在治疗6个月,观察组血清HBV DNA水平为（2.2±0.6）lg copies/ml,显著低于对照组（P>0.05）;血清总胆红素水平和凝血酶原时间国际标准化比值分别为（32.9±5.7）μmol/L和（1.3±0.1）,均显著低于对照组的【（45.9±6.2）μmol/L和（1.5±0.1）,P<0.05】;血清白蛋白水平为（38.7±3.8）g/L,显著高于对照组的【（33.6±3.5）g/L,P<0.05】;血小板计数为（98.1±3.4）×10⁹/L,显著高于对照组的（87.4±3.2）×10⁹/L（P<0.05）;观察1年,观察组出现2例（2.9%）自发性细菌性腹膜炎,2例（2.9%）上消化道出血,对照组出现4例（5.9%）腹膜炎,6例（8.8%）消化道出血和4例（2.9%）肝性脑病。结论 应用拉米夫定和阿德福韦酯联合治疗乙型肝炎肝硬化患者有较好的近期疗效。     

白蛋白输注联合腹腔置管持续引流与支链氨基酸联合利尿剂治疗失代偿期肝硬化张力性腹水的效果对比分析

目的 观察白蛋白输注联合腹腔置管持续引流与支链氨基酸联合利尿剂治疗肝硬化张力性腹水患者的疗效差异。方法 2014年12月~2016年 8月我院收治的78例肝硬化张力性腹水患者被随机分为对照组32例,给予白蛋白联合腹腔置管持续引流治疗,试验组46例接受支链氨基酸联合利尿剂治疗,疗程均为2 w。结果 在治疗2 w末,试验组与对照组肝性脑病（x²=5.472,P<0.05）和自发性细菌性腹膜炎发生率（x²=4.092,P<0.05）有显著性差异;试验组24 h尿量为（1321±278） ml,显著多于对照组的（1102±239） ml（P<0.05）;两组血清TBIL[（36.8±23.1） μmol/L 对（36.3±26.8） μmol/L,P>0.05]、PT-INR [（1.05±0.91）对（1.16±1.03）,P>0.05]、 ALB[（32.9±9.1） g/L 对（30.7±8.5） g/L,P>0.05]、Cr [（65.2±45.7）μmol/L对（72.4±38.8）μmol/L,P>0.05]均无显著性相差。结论 白蛋白联合腹腔置管持续引流是治疗肝硬化张力性腹水公认有效的方法,而应用支链氨基酸联合利尿剂具有相对安全、剂量可控、价格低廉、无创的特点,短期效果也较好。     

恩替卡韦联合聚乙二醇干扰素或胸腺素治疗代偿期乙型肝炎肝硬化2年疗效随访*

目的 探讨应用恩替卡韦联合聚乙二醇干扰素α-2a（PEG-IFNα-2a）或胸腺素治疗代偿期乙型肝炎肝硬化患者的效果。方法 在88例代偿期乙型肝炎肝硬化患者中,接受恩替卡韦治疗者38例,接受恩替卡韦联合PEG-IFNα-2a治疗者17例,联合胸腺素治疗者33例,随访2年。结果 恩替卡韦治疗组治疗前和治疗104 w末血清HBV DNA水平分别为（5.6±1.7） IU/ml和（1.0±0.7） IU/ml（P<0.05）,联合PEG-IFNα-2a组分别为（5.8±1.3） IU/ml和（1.0±0.7） IU/ml（P<0.05）,联合胸腺素组分别为（6.1±2.0） IU/ml和（1.0±0.9） IU/ml（P<0.05）;恩替卡韦组治疗前和治疗104 w末血清ALB水平分别为（43.1±5.4） g/L和（46.9±4.9） g/L（P<0.05）,联合胸腺素组分别为（43.0±4.0） g/L和（46.8±5.4） g/L（P<0.05）;三组治疗前和治疗104 w末肝脏硬度值和INR无统计学差异（P>0.05）。结论 恩替卡韦能有效抑制HBV DNA复制,维持代偿期肝硬化患者的肝功能,本研究结果看不出联合用药有任何好处,需要进一步观察。     

丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化患者疗效及其对血清BGP水平的影响*

目的 探讨应用丁二磺酸腺苷蛋氨酸肠溶片联合复方甘草酸苷治疗酒精性肝硬化患者的疗效及其对血清骨钙素（BGP）水平的影响。方法 2016年3月~2018年2月我院诊治的酒精性肝硬化患者276例,采用随机数字表法分为观察组（n=138）和对照组（n=138）。给予对照组患者丁二磺酸腺苷蛋氨酸肠溶片口服,观察组患者在对照组治疗的基础上给予复方甘草酸苷注射液静脉滴注,治疗3 w。采用放射免疫法检测血清BGP水平,采用ELISA法检测血清胰岛素样生长因子1（IGF-1）水平,采用化学发光免疫法检测血清透明质酸（HA）、黏连蛋白（LN）、IV型胶原（IV-C）和III型前胶原（PC-III）水平。结果 在治疗结束时,观察组血清ALB为（36.8±10.3） g/L,显著高于对照组[（29.4±9.2） g/L,P<0.05],血清TBIL为（26.4±5.1） μmol/L,显著低于对照组[（47.3±9.4） μmol/L,P<0.05],血清GGT水平为（158.6±72.8） U/L,显著低于对照组[（254.6±100.4） U/L,P<0.05];观察组血清HA为（72.6±18.4） μg/L,显著低于对照组[（158.4±30.5） μg/L,P<0.05],LN为（87.4±8.3） μg/L,显著低于对照组[（165.3±19.8） μg/L,P<0.05],PC-III为（94.5±31.3） μg/L,显著低于对照组[（147.4±42.5） μg/L,P<0.05],IV-C为（64.3±9.5） μg/L,显著低于对照组[（98.4±26.4） μg/L,P<0.05];观察组血清IGF-1水平为（198.2±34.6）ng/ml,显著高于对照组[（162.5±30.5） ng/ml,P<0.05],BGP为（8.8±3.9） ng/ml,显著高于对照组[（6.7±3.0） ng/ml,P<0.05]。结论 应用丁二磺酸腺苷蛋氨酸肠溶片联合复方甘草酸苷治疗酒精性肝硬化患者近期疗效显著,可显著改善患者肝功能指标,可能与升高了血清IGF-1和BGP水平有关。     

自体外周血干细胞移植治疗乙型肝炎肝硬化患者临床疗效及其对外周血T淋巴细胞亚群的影响

目的 研究应用自体外周血干细胞（PBSC）移植治疗乙型肝炎肝硬化患者的临床疗效及其对外周血T淋巴细胞亚群的影响。方法 2014年4月~2017年4月我院收治的乙型肝炎肝硬化患者95例,被随机分为移植组48例和对照组47例。两组均接受护肝、降酶和恩替卡韦抗病毒治疗,另48例患者再接受自体PBSC经肝动脉移植治疗。使用流式细胞仪检测外周血T细胞亚群,使用Fibroscan扫描仪检测肝脏硬度,采用ELISA法检测血清肿瘤坏死因子（TNF-α）和白细胞介素-6 （IL-6）,采用免疫透射比浊法检测血清超敏C反应蛋白（hs-CRP）。结果 在治疗后6 m,移植组患者血清总胆红素（TBIL）水平为（16.4±1.2） μmol/L,显著低于对照组的（22.5±2.6） μmol/L（P<0.05）,血清白蛋白（ALB）水平为（35.2±4.0） g/L,显著高于对照组的（31.6±3.7） g/L（P<0.05）;移植组外周血CD3⁺细胞百分比为（67.9±6.5） %,显著高于对照组的【（60.3±5.5） %,P<0.05】,CD4⁺为（42.7±3.8） %,显著高于对照组的【（38.2±3.5） %,P<0.05】,CD4⁺/ CD8⁺细胞比值为（1.5±0.2）,显著高于对照组的【（1.4±0.1）,P<0.05】;移植组肝硬度值为（7.1±0.1）kPa,显著低于对照组[（7.9±0.1） kPa,P<0.05],Child-Pugh评分为（5.5±1.5）,显著低于对照组[（7.4±2.3）,P<0.05];移植组血清TNF-α水平为（28.0±8.7） pg/mL,显著低于对照组[（36.2±8.6）pg/mL,P<0.05], IL-6水平为（6.0±2.2） mg/L,显著低于对照组[（8.7±3.5） mg/L,P<0.05], hs-CRP水平为（18.9±5.6） pg/mL,显著低于对照组[（25.2±7.9） pg/mL,P<0.05]。结论 自体外周血干细胞移植治疗乙型肝炎肝硬化患者近期疗效较好,能有效降低血清细胞因子水平,改善肝功能。     

乙型肝炎肝硬化患者血清B7-H3和IL-18水平变化及其临床意义探讨

目的 通过检测乙型肝炎肝硬化患者血清B7-H3和白细胞介素-18（IL-18）水平,探讨它们水平变化与疾病进展的相关性。方法 2015年4月~2017年3月纳入113例乙型肝炎肝硬化患者,其中代偿期肝硬化患者33例,失代偿期肝硬化患者80例,和健康志愿者20名。采用ELISA法检测血清B7-H3和IL-18水平,采用直线相关分析肝硬化患者血清B7-H3与IL-18水平间的相关性。结果 80例失代偿期肝硬化患者血清B7-H3水平为（62.29±22.17） ng/ml,显著高于33例代偿期肝硬化患者的（32.27±10.29） ng/ml（P<0.05）或20例健康人的（11.35±4.48） ng/ml（P<0.05）,代偿期肝硬化患者血清B7-H3水平也显著高于健康人（P<0.05）;失代偿期肝硬化患者血清IL-18水平为（585.63±121.28） pg/ml,显著高于代偿期肝硬化患者的（396.29±86.91） pg/ml（P<0.05）或健康人的（155.31±76.93） pg/ml（P<0.05）,代偿期肝硬化患者血清IL-18水平也显著高于健康人（P<0.05）;肝硬化患者血清B7-H3水平与IL-18水平间呈显著正相关（r=0.4111,P<0.01）;26例Child-Pugh C级患者血清B7-H3水平为（76.53±22.76） ng/ml,显著高于33例Child-Pugh A级患者的（23.27±9.84） ng/ml或54例Child-Pugh B级患者的（52.21±13.94） ng/ml（P<0.05）,Child-Pugh C患者IL-18水平为（594.13±112.21） pg/ml,显著高于Child-Pugh B级患者的（408.06±92.41） pg/ml或Child-Pugh A级患者的（243.82±57.03） pg/ml（P<0.05）,Child-Pugh B级患者血清IL-18水平也显著高于Child-Pugh A级（P<0.05）。结论 乙型肝炎肝硬化患者血清B7-H3和IL-18水平升高,两者呈正相关,提示B7-H3可能是乙型肝炎肝硬化患者一个预后不良因子,通过与IL-18的协同作用,引起体内免疫功能紊乱,加重了肝细胞损伤,从而促进了疾病的发生和发展。     

恩替卡韦联合双歧杆菌乳杆菌三联活菌片治疗失代偿期乙型肝炎肝硬化临床疗效观察

目的 探讨恩替卡韦联合双歧杆菌乳杆菌三联活菌片治疗失代偿期乙型肝炎肝硬化患者的临床疗效。方法 2015年3月~2017年8月我院收治的120例失代偿期乙型肝炎肝硬化患者被随机分为对照组60例和观察组60例,分别给予恩替卡韦分散片或恩替卡韦联合双歧杆菌乳杆菌三联活菌片治疗,观察24 w。结果 在治疗12 w时,观察组血清TBIL为（16.3±4.2） μmol/L,显著低于对照组的（26.3±5.2） μmol/L（P<0.05）,观察组血清ALB为（32.5±4.2）g/L,显著高于对照组的（30.2±5.3） g/L（P<0.05）;在治疗24 w时,观察组血清ALB为（37.8±2.3） g/L,显著高于对照组的（34.4±4.2） g/L（P<0.05）;观察组血清LN和C- IV分别为（65.2±15.1）ng/ml和（85.5±8.5） ng/ml,显著低于对照组的【（75.3±10.3） ng/ml和（96.2±10.3） ng/ml,P<0.05】;观察组血清HBV DNA水平为（1.0±0.1） lg copies/ml,与对照组的（1.7±0.3） lg copies/ml比,无显著性差异（P>0.05）,血清HBV DNA转阴率为100.0%,与对照组的90.0%比,无显著性差异（P>0.05）;在治疗12 w和24 w,观察组发生自发性细菌性腹膜炎（SBP）5例（8.3%）和2例（3.3%）,显著低于对照组的10例（16.7%）和8例（13.3%,P<0.05）;在治疗24 w末,观察组死亡3例（5%）,而对照组死亡10例（16.7%,P<0.05）。结论 恩替卡韦联合双歧杆菌乳杆菌三联活菌治疗失代偿期乙型肝炎肝硬化患者能短期改善肝功能指标,降低血清肝纤维化指标水平,减少并发症的发生。     

乙型肝炎肝硬化患者血清血小板衍生生长因子和叶酸水平变化

目的 分析乙型肝炎肝硬化患者血清血小板衍生生长因子（PDGF）和叶酸水平变化。方法 2015年1月~2016年12月期间我院收治的110例乙型肝炎肝硬化患者,常规行肝功能Child-Pugh分级,采用ELISA法检测血清PDGF水平,采用化学发光法检测血清叶酸水平,采用放射免疫法检测血清Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（Ⅳ-C）、层粘连蛋白（LN）和透明质酸酶（HA）水平。结果 32例Child-Pugh C级患者血清PDGF水平为（190.7±11.4）pg/ml,显著高于42例B级或36例A级患者的（128.5±8.1） pg/ml或（79.5±4.9） pg/ml（P<0.05）;Child-Pugh C级患者血清叶酸水平为（2.7±0.5） μg/L,显著低于B级或A级患者的（5.3±0.5） μg/L或（7.1±0.8） μg/L（P<0.05）;Child-Pugh C级患者血清谷丙转氨酶（ALT）、总胆红素（TBIL）水平和INR水平分别为（102.4±6.9） U/L、（60.7±5.8） μmol/L和（1.9±0.2）,均显著高于B级患者【分别为（78.9±4.5） U/L、（36.4±3.2） μmol/L和（1.5±0.2）】或A级患者[分别为（56.8±3.9） U/L、（26.8±2.8） μmol/L和（1.2±0.1）,均P<0.05】;Child-Pugh C级患者血清白蛋白（ALB）为（23.9±2.4） g/L,显著低于B级患者的（30.8±2.7） g/L或A级患者的（41.0±3.3） g/L（均P<0.05）;Child-Pugh C级患者血清PCⅢ、Ⅳ-C、LN和HA水平分别为（279.7±19.2） μg/L、（140.4±8.0） μg/L、（159.7±8.2） μg/L和（237.8±9.1） μg/L,均显著高于B级分别为【（238.5±17.8） μg/L、（94.8±6.2） μg/L、（129.5±7.3） μg/L和（174.1±8.6） μg/L或A级患者（分别为158.6±13.6）μg/L、（75.4±5.1） μg/L、（96.8±6.8） μg/L和（128.3±6.9）μg/L,均P<0.05】;肝硬化患者血清PDGF水平与ALT、TBIL、INR和肝纤维化指标均呈正相关,与ALB呈负相关（均P<0.05）,叶酸水平与ALT、TBIL、INR和肝纤维化指标均呈负相关,与ALB呈正相关（均P<0.05）。结论 随着肝功能损害程度的加重,肝硬化患者血清PDGF水平逐渐升高,而叶酸水平逐渐降低,其临床意义还有待于进一步研究。     

细菌感染诱发乙型肝炎肝硬化患者发生肝性脑病60例回顾性研究

目的 总结乙型肝炎肝硬化患者发生肝性脑病（HE）与细菌感染的相关性。方法 回顾性分析60例由细菌感染诱发的肝性脑病和60例乙型肝炎肝硬化的临床资料,应用SPSS 20.0统计软件包进行统计学分析。结果 60例HE患者血清白蛋白为（24.3±6.1） g/L,显著低于肝硬化患者的（26.8±3.9） g/L;肝硬化患者血清丙氨酸氨基转移酶、总胆红素、肌酐、INR和白细胞计数分别为（112.6±18.5） U/L、（79.7±23.0） μmol/L、（71.5±16.1） μmol、（1.9±0.4）和（6.8±2.5）×10⁹/L,明显低于HE组的（201.3±59.4） U/L、（112.6±33.4） μmol/L、（98.6±26.4） μmol、（2.1±0.60和（10.9±2.7）×10⁹/L,差异具有统计学意义（P<0.05）;腹膜炎和呼吸系统感染患者发生3期和4期HE的比率显著高于泌尿系统或其他部位感染者 （x²=13.34,P<0.001）。结论 合并细菌感染的乙型肝炎肝硬化患者更容易诱发肝性脑病,应注意预防。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.