艾滋病合并肺结核64例临床研究

目的 探讨艾滋病合并肺结核的临床特点及治疗.方法 对64例艾滋病合并肺结核患者资料进行分析研究.结果 64例患者人类免疫缺陷病毒(HIV)感染途径为静脉吸毒(79.7%)及性途径(18.7%).临床表现有持续发热(96.8%),咳嗽(81.2%),腹泻(32.8%),结核菌纯蛋白衍生物试验(PPD)试验阴性率78.1%,全身浅表淋巴结肿大(71.9%),胸部X线表现以继发性肺结核为主(65.6%),经抗结核及抗HIV病毒治疗,大部分患者症状体征及胸片改善.抗结核不良反应发生率高.结论 艾滋病合并肺结核常发病急,症状重,PPD试验阳性率低,抗结核药物治疗不良反应多,临床应尽可能同时进行抗结核与抗HIV病毒治疗,应提高艾滋病高发区及高危人群肺结核患者并发艾滋病的警惕性.     

Toxoplasma pericarditis in acquired immunodeficiency syndrome

Large pericardial effusions are now a well-known complication of the acquired immunodeficiency syndrome, mainly caused by mycobacterial disease. However, other etiologies can be found. We report a case of toxoplasma pericarditis without other parasitic localizations. Pericarditis is a very uncommon clinical feature during toxoplasmosis. Its diagnosis is often difficult to establish, particularly in immunocompromised patients. Nevertheless, its possible evolution to constriction or tamponade requires its consideration. New methods of rapid tissue cultures may be helpful and allow early specific treatment.     

艾滋病合并播散性巨细胞病毒感染

报告５１例艾滋病（ＡＩＤＳ）合并巨细胞病毒（ＣＭＶ）感染的病理学表现。男４３例女８例，平均３８．６岁。ＣＭＶ感染主要累及消化道（９２．１％）、肺（７８．４％）和肾上腺（５４．９％），感染特征为巨细胞及核内包涵体形成，导致局部组织变性坏死和单个核细胞浸润。ＣＭＶ感染常合并其它条件性病原体或卡波西肉瘤。结合文献对其病理特征及诊断进行探讨。     

艾滋病伴发腹部结核的超声表现

目的 探讨艾滋病伴发腹部结核的超声表现特征.方法 回顾性分析88例艾滋病伴发腹部结核患者超声资料.结果 88例艾滋病伴发腹部结核患者中,超声表现为腹部淋巴结肿大者66例（75.00%）,其中31例伴发颈部淋巴结肿大,18例表现为分叶状融合团块,其内可见大片细小点状回声漂浮的无回声区;肝脏结核47例（53.41%）,其中肝肿大40例,肝实质局灶性病变13例,表现为大小、分布较均匀的高或低回声结节;脾脏结核49例（10.63%）,脾肿大41例,脾实质病变15例,其中局灶性病变14例,表现为多发均匀低回声小结节,弥漫性病变1例,呈＂虫蚀样＂改变;肠结核8例（9.09%）;胰腺结核2例（2.27%）;沁尿系统结核2例（2.27%）;腹水14例（15.91%）.结论 艾滋病伴发腹部结核超声表现与病理相符,病变内未见钙化出现,容易形成大面积液化;多个脏器同时受累多见,淋巴结、肝、脾是最常受累的部位.     

Increased production of IgE protein and IgE antibodies specific for fungal antigens in patients with the acquired immunodeficiency syndrome

Summary Levels of IgE protein and IgE antibodies specific for 8 different allergenic extracts were measured in the serum of a large series of patients infected by the human immunodeficiency virus (HIV) and in HIV-seronegative subjects belonging to the same risk groups (intravenous drug-users, homosexual men and hemophiliacs). The proportion of subjects showing elevated IgE levels was higher among HIV-infected patients with group IV disease than among HIV-infected patients with group II–III diseases or seronegative individuals. In addition, many HIV-infected patients with elevated IgE levels showed the presence in their serum of IgE antibodies specific for fungal antigens. This work was supported by grants from theConsiglio Nazionale delle Ricerche (CNR), Roma, Italy,Progetto Finalizzato ‘Oncologia’ and from theAssociazione Italiana per la Ricerca sul Cancro (AIRC). M. Mazzetti and D. Macchia were supported by a fellowship of AIRC. P. Parronchi was supported by a fellowship ofAssociazione Nazionale per la Lotta contro l’AIDS.     

获得性免疫缺陷综合征局灶性脑炎1H-MRS分析

目的 探讨¹H-MRS对获得性免疫缺陷综合征(AIDS)局灶性脑炎的诊断及鉴别诊断价值。 方法 对确诊的23例AIDS局灶性脑炎患者进行MR检查,以¹H-MRS分析32个病灶,测量代谢物N-乙酰天门冬氨酸(NAA)、胆碱化合物(Cho)、肌酸(Cr)、肌醇(mI)峰下面积均值,观察乳酸(Lac)、脂质(Lip)峰出现的频数,计算NAA/Cr、Cho/Cr、mI/Cr、NAA/Cho、(Cho+mI)/NAA值。比较AIDS局灶性脑炎实性区、坏死区、水肿区及与相邻正常脑组织代谢物差异。 结果 AIDS局灶性脑炎病变各区均出现NAA、Cho、Cr、mI峰。与相邻正常脑组织比较,NAA峰在病变各区均降低,Cho、mI峰在实性区略升高,在坏死及水肿区降低。Lac、Lip峰在病变各区均出现,在实性及坏死区出现频数明显高于水肿区,且Lip峰出现频数较Lac峰高。病变各区之间NAA/Cr、NAA/Cho、Cho/Cr、(Cho+mI)/NAA值差异有统计学意义(P<0.05);与相邻正常脑组织比较,病变各区Cho/Cr、(Cho+mI)/NAA值差异均有统计学意义(P均<0.05)。 结论 ¹H-MRS能够发现AIDS局灶性脑炎的特征性物质及能量代谢变化,为定性、定量诊断和鉴别诊断提供依据。     

Drug-induced erythroderma in patients with acquired immunodeficiency syndrome

BACKGROUND: To explore the clinical manifestations, diagnosis, and treatment of patients with acquired immunodeficiency syndrome (AIDS) complicated with drug-induced erythroderma. METHODS: The clinical data of 12 AIDS patients with drug-induced erythroderma in our hospital were retrospectively analyzed. The general information, offending medications, complications, modified severity-of-illness score for toxic epidermal necrolysis (SCORTEN) scores, and disease outcome spectrums were analyzed. RESULTS: Drug-induced erythroderma was mostly caused by antiviral drugs, antituberculosis drugs, antibiotics, traditional Chinese medicine, and immune checkpoint inhibitors. The spectrum of sensitizing drugs was broad, the clinical situation was complex, and infections were common. The affected areas were greater than 40% body surface area in all patients. The modified SCOTERN score averaged 3.01±0.99. All patients were treated with glucocorticoids, and nine patients were treated with intravenous immunoglobulin (IVIG) pulse therapy at the same time. The average time to effectiveness was 7.08±2.23 days, and the average hospital stay was 17.92±8.46 days. Eleven patients were cured, and one patient died of secondary multiple infections, who had a modified SCORTEN score of 5 points. The mortality rate in this study was 8.3%. CONCLUSIONS: The clinical situation of AIDS patients with drug-induced erythroderma in hospitalized patients is complex and the co-infection rate is high. The use of modified SCORTEN score may objectively and accurately assess the conditions, and the use of glucocorticoid combined with IVIG therapy may improve the prognosis.     

获得性免疫缺陷综合征并发弓形体脑炎的1H-MRS特点

目的 探讨获得性免疫缺陷综合征(AIDS)并发弓形体脑炎的¹H-MRS的特点。方法 收集13例确诊为AIDS并发弓形体脑炎的患者,分析其39个病灶¹H-MRS特点。结果 由病灶实性区、水肿区到对侧正常区N-乙酰天门冬氨酸/磷酸肌酸和肌酸(NAA/Cr)、N-乙酰天门冬氨酸/胆碱类化合物(NAA/Cho)呈逐渐升高趋势,胆碱类化合物/磷酸肌酸和肌酸(Cho/Cr)、肌醇/肌酸(MI/Cr)呈逐渐下降趋势。AIDS合并弓形体脑炎病灶水肿区与对侧正常区、病灶实性区与对侧正常区的NAA/Cr、NAA/Cho比值差异均有统计学意义(P均<0.05);病灶实性区与水肿区的NAA/Cho、MI/Cr比值差异有统计学意义,病灶实性区与对侧正常区的MI/Cr比值差异有统计学意义(P<0.05)。结论 ¹H-MRS对于AIDS并发弓形体脑炎的诊断提供代谢性信息,可作为常规MR检查的补充,但其波谱表现特异性较低。     

Investigation of perceived stigma among people living with human immunodeficiency virus/acquired immune deficiency syndrome in Henan Province,China

PurposeTo investigate the level of and factors influencing perceived stigma and discrimination among people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (PLWHA) in Henan Province.MethodsIn total, 161 PLWHA from Zhengzhou and Zhenping were investigated using the Berger HIV stigma scale.ResultsThe mean Berger stigma scale score was 105.70 ± 15.20, indicating a middle stigma level. Among the four subscales of the Berger stigma scale, the disclosure concerns score was highest, while the negative self-image score was lowest. Multivariate analyses showed that factors influencing perceived HIV stigma included the level of education and route of infection.ConclusionThe level of perceived HIV stigma and discrimination among PLWHA in Henan Province is moderate and was affected by the level of education and route of infection. Special intervention should be established to address this problem.     

Cytomegalovirus colitis in acquired immune deficiency syndrome: Radiologic spectrum

Six cases of cytomegalovirus (CMV) colitis are described. The radiographic manifestations of this colitis are nonspecific and usually mimic the findings of ulcerative colitis with diffuse mucosal ulceration or granulomatous colitis with aphthous ulceration and skip areas. Terminal ileal involvement was noted in 1 patient. Nonspecific edema was present in 2 other cases. One patient demonstrated unusual cecal and ascending colonic nodularity due to pseudomembranes and, in another, large flat discrete ulcerations were identified. Angiography, in 1 case, demonstrated marked hypervascularity and identified a site of hemorrhage in the ascending colon.With the radiographic identification of colitis in an immunocompromised patient, particularly a patient with acquired immunodeficiency syndrome (AIDS), CMV colitis must be strongly considered in the differential diagnosis. Endoscopic biopsy is the most effective method of establishing the diagnosis.     

ARDS中肺泡巨噬细胞自噬对肺损伤调节作用的研究进展

失控的炎症反应是急性呼吸窘迫综合征（ARDS）发生发展的关键环节,而肺泡巨噬细胞自噬在ARDS的炎症反应中发挥重要的调节作用。本文对相关文献进行回顾,以深入了解在ARDS中肺泡巨噬细胞发生自噬的具体机制及肺泡巨噬细胞自噬对肺损伤的影响,为ARDS的治疗提供进一步的研究方向。     

Acquired immunodeficiency syndrome (AIDS)

This review article on acquired immunodeficiency syndrome (AIDS) covers its epidemiology, clinical spectrum, and etiology. Despite intensive efforts, the cause and pathogenesis of this syndrome remain unknown and effective therapy is not yet available. In addition, the clinical presentation of AIDS is variable, ranging from generalized lymphadenopathy to dermatologic lesions, pneumonias, enteritis, ophthalmologic lesions, disseminated disease, malignancies, neurologic conditions, paresthesias, radiculopathies, seizures, and psychiatric manifestations. The population at risk for AIDS icludes homosexual or bisexual men (71% of cases), intravenous drug abusers (17%), those born in Haiti who recently migrated to the US (5%), and hemophiliacs (1%). 6% of cases reported to the US Centers for Disease Control (CDC) fall in none of these categories. 47% of AIDS patients are 30-39 years of age at time of diagnosis. The CDC's strict surveillance definition of AIDS represents only 1 end of the clinical spectrum and could result in an underestimate of the size of the problem. It ignores the prodromal or milder forms of AIDS-related illnesses that have less clearly defined clinical courses. The persistent, irreversible immunosuppression characteristic of this syndrome creates a complex management problem for physicians, but the early recognition of AIDS by emergency and primary care physicians may improve the grim prognosis for AIDS victims.     

HIV/AIDS患者B7-H1的表达特点及与疾病进展关系研究

目的 研究HIV/AIDS患者外周血mDC及不同亚群T淋巴细胞B7-H1及PD-1的表达水平,分析其与疾病进展的相关性,探讨B7-H1及PD-1信号通路在HIV感染中的作用.方法 采集中国医科大学附属第一医院艾滋病研究所红丝带门诊36例未经抗病毒治疗的HIV/AIDS患者(无症状HIV组、AIDS组)及20名健康对照组...     

Management of acquired von Willebrand syndrome

Acquired von Willebrand syndrome (AVWS) is a rare acquired bleeding disorder that resembles von Willebrand disease by its clinical symptoms and laboratory findings, but differs by its negative personal and family history of bleeding diathesis. AVWS is mostly seen in the elderly, but it has been described in children, often in those with congenital heart disease and Wilms tumor. It is most commonly associated with lymphoproliferative, myeloproliferative, cardio-vascular, or autoimmune diseases, solid tumors, and certain drugs. The diagnosis should be suspected in a patient who is known for one of these underlying conditions and who presents with new onset of bleeding or who will be undergoing an invasive procedure. Treatment of the underlying condition, when possible, usually results in correction of AVWS. When acute bleeding occurs or the underlying condition is not treated, emphasis should be put on control and prevention of bleeding. Many options are available. DDAVP is the first line of treatment for bleeding. vWF concentrates are used to treat bleeding that is unresponsive to DDAVP and as prophylaxis before procedures. This review summarises current knowledge and reviews the different management options for bleeding.     

艾滋病合并肺结核的X线平片分析

目的探讨艾滋病（AIDS）合并肺结核（PTB）的胸部X线影像表现。方法回顾性分析42例AIDS合并PTB的正侧位X线胸片，42例均有胸部CT检查资料。结果42例中浸润型肺结核30例，其中合并胸腔积液8例，血行播散型肺结核7例，原发型肺结核5例；肺部阴影多为大片状或小片状互相融合状，边缘模糊，其中可有空洞；肺门、纵隔淋巴结肿大多见；病灶分布广泛，常常双肺多叶多段同时受累。结论胸部X线检查对艾滋病合并肺结核的诊断以及在确定病变的范围与程度、抗结核治疗动态效果评价等方面具有重要价值。     

Acrophialophora fusispora brain abscess in a patient with acquired immunodeficiency syndrome: a case report and review of the literature

We reported a fatal case of brain abscess caused by Acrophialophora fusispora in a patient with acquired immunodeficiency syndrome. Identification of the fungus was based on microscopic morphology and sequence analyses of the internal transcribed spacer 1 (ITS1) and 2 (ITS2) of ribosomal RNA gene from the isolate recovered from brain abscess. Four published cases were reviewed as well.     

转化生长因子β与肺泡巨噬细胞在肺纤维化中的作用研究进展

肺纤维化（pulmonary fibrosis,PF）是较为严重的呼吸系统疾病。转化生长因子β（TGF—β）在肺纤维化过程中扮演着重要的角色,是最关键的致纤维化细胞因子。肺泡巨噬细胞（alveolar macrophage,AM）是主要的炎症细胞,能合成和释放TGF-β以及其它炎症介质,在炎症损伤及修复过程中都发挥了重要作用。本文对TGF-β以及AM在肺纤维化中的作用作一综述。     

Symptomatic hypercalcemia as presenting manifestation of lymphoma in a patient with acquired immunodeficiency syndrome

Hypercalcemia can be an uncommon manifestation of various infections and malignancies in HIV-positive patients. A case of severe symptomatic hypercalcemia as the first sign of non-Hodgkin's lymphoma in a patient found later to be HIV positive is presented. Differential diagnosis of calcium disorders should include test for HIV and underlying conditions including lymphoma in the diagnostic work up.     

实时荧光定量PCR在测定艾滋病患者肠道菌群量变化中的应用及意义

目的:应用实时荧光定量PCR观察艾滋病患者肠道菌群量的变化,研究艾滋病对肠道微生态的影响及其在发病中的作用。方法:分别设计双歧杆菌属、乳酸杆菌属、大肠杆菌、粪肠球菌及屎肠球菌的特异性引物。收集艾滋病患者粪便标本30份及正常对照标本30份,提取细菌基因组DNA,应用实时荧光定量PCR反应测定5种细菌的数量。结果:艾滋病患者组双歧杆菌属、乳酸杆菌属的数量较正常对照组明显减少;大肠杆菌、粪肠球菌、屎肠球菌数量明显增多,差异有统计学意义(P<0.05)。结论:艾滋病患者肠道微生态发生了明显变化,提示艾滋病患者肠道微生态紊乱。     

艾滋病合并肺结核病患者的影像分析

目的对艾滋病（AIDS）合并肺结核病患者进行影像学分析,为认识和诊断AIDS合并肺结核提供依据。方法回顾分析2008年1月一2011年1月21例确诊AIDS合并肺结核患者（观察组）的临床及影像学资料,并与30例单纯肺结核患者（对照组）对比。结果21例AIDS合并肺结核中17例累及2个或以上肺段,14例影像学表现为磨玻璃影,7例伴弥漫粟粒性病灶,8伴肺门和（或）纵隔淋巴结肿大,5例伴有肺外结核;而30例单纯肺结核中,20例仅累及1个肺段,21例影像表现为实变影或斑片影,20例伴有纤维增殖灶,16例有1个或多个空洞;以上影像学特征发生率两组差异有统计学意义。两组胸腔积液发生率差异无统计学意义。结论AIDS合并肺结核与单纯肺结核在影像学表现上有明显差别,且具有一定影像学特征,主要表现多种性质的病灶共存、多形态、多叶、段分布,了解其相关临床影像表现特征有利于AIDS并发肺结核的早期诊断和治疗。