艾滋病及其口腔疾病(二)

艾滋病及其口腔疾病（二）史久成陈桂玲４口腔病变：一般认为潜伏期为１１个月至４年．Ｈａｒｄｉｅ（１９８６）认为２个月至５年半．ＡＩＤＳ发病前过程包括淋巴结肿大症候群（ＬＡＳ）和艾滋病相关症候群（ＡＲＣ）．估测至少１／５的ＡＲＣ病人会发展成ＡＩＤＳ病人．...     

口腔表征为首诊的艾滋病2例报告

通过分析2例因口腔表现首诊的艾滋病患者的临床资料,探讨如何通过口腔表现的症状,及早发现和诊断艾滋病病毒感染者,防止该病的传播.     

口腔扁平苔藓病损中郎格罕氏细胞与T细胞的关系

本文应用免疫组织化学技术对口腔扁平苔藓病损中的郎格罕氏细胞数量，分布情况及与Ｔ细胞的关系进行了研究，结果显示口腔扁平病损中郎格罕氏细胞周围有ＨＬＡ－ＤＲ阳性的Ｔ细胞及角朊细胞，并且发现郎格罕氏细胞与Ｔ细胞有接触关系。作者认为郎格罕氏细胞与Ｔ细胞之间的密切接触在递呈抗原及启动局部免疫反应过程中起重要作用。     

人类免疫缺陷病毒感染的口腔表现

大多数人类免疫缺陷病毒感染者具有口腔表现,且许多患者的口腔表现在发病的初期,常作为首发症状首先就诊于口腔科。本文着重对ＨＩＶ感染者口腔真菌感染、病毒感染、口腔肿瘤以及其它疾病的口腔表现作一综述。     

树突状细胞与口腔疾病

树突状细胞 (ｄｅｎｄｒｉｔｉｃｃｅｌｌｓ ,ＤＣ)是目前发现的功能最强的抗原提呈细胞。近年来研究重点是关于树突状细胞的来源和分化发育 ,树突状细胞对外源性抗原的摄取加工 ,树突状细胞与免疫激活 ,树突状细胞与自身免疫性疾病。1　树突状细胞的来源和分化发育通过对不同组织来源ＤＣ的研究发现 ,体内ＤＣ主要分为髓系ＤＣ(Ｍｙｅｌｏｉｄ -ｄｅｒｉｖｅｄＤＣ)和淋巴系ＤＣ(Ｌｙｍｐｈｏｉｄ -ｒｅｌａｔｅｄＤＣ)两大类。目前用于研究的髓系ＤＣ包括ＣＤ34 (ｃｌｕｓｔｅｒｏｆｄｉｆｆｅｒｅｎｔｉａｔｉｏｎ ,ＣＤ)干细胞来源的Ｄ…     

HIV感染者口腔念珠菌负荷及生物型研究

目的调查人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染者口腔中念珠菌负荷状况、生物分型及与口腔念珠菌病临床表现的关系。方法采取漱口法对64例HIV感染者和42名健康对照者进行口腔念珠菌的定量分离培养，并综合利用革兰染色、厚壁孢子生成实验、CHROMagar显色培养和API 20C AUX酵母菌鉴定系统对分离株进行生物型鉴定。结果64例HIV感染者中，52例中可分离出念珠菌74株，阳性分离率为81．3％，而42名健康对照者口腔念珠菌阳性分离率仅为16．7％（P〈0．001）。通过对74株念珠菌的生物型进行鉴定，发现有39株白色念珠菌，15株热带念珠菌及其他6个生物型20株。健康对照组中，分离出5株白色念珠菌和其他裂2株。结论HIV感染者口腔念珠菌感染率明显增加，其口腔念珠菌的检出率和负荷量亦明显增加，白色念珠菌和热带念珠菌为其主要分离菌；与健康对照组相比，HIV感染者的口腔念珠菌分离株生物类型旱现多样化。     

Oral manifestation of sporotrichosis in AIDS patients

A wide spectrum of oral lesions has been associated with human immunodeficiency viral infection (HIV), or AIDS. This report describes the case of an HIV-infected patient who developed a case of disseminated sporotrichosis whose first clinical sign was the presence of orofacial lesions. A histopathological study of this patient's biopsy specimens taken from the oropharyngeal lesions revealed a number of rounded and/or oval free-spore forms of Sporothrix schenkii, the identification of which was corroborated by culturing skin lesion exudate on Sabouraud's glucose agar. To the best of our knowledge to date, this is the first time a case of the oral manifestation of sporotrichosis in association with HIV infection has been described in the dental literature.     

72例HIV/AIDS口腔病损的临床观察

目的：分析HIV感染者和AIDS患者常见口腔病损,以期提高临床医师对AIDS早期临床表现的认识,提高早期诊断准确性。方法：回顾分析72例HIV／AIDS患者临床症状、体征和实验室检查,分析口腔病损在AIDS早期诊断中的意义及与病程进展的关系。结果：常见口腔病变有：口腔白色念珠菌病、疱疹性口炎、非特异性口腔溃疡,其它病损如颌面部淋巴结炎、毛状白斑、卡波济肉瘤、带状疱疹、涎腺肿大,牙周病等,可单发或同时伴发。全身系统性疾病主要包括：肺炎、慢性腹泻、结核等。结论：AIDS患者发病前已开始出现明显口腔表现,其中以口腔白色念珠菌感染最为常见,对非法采供血、输血、静脉吸毒或不安全性行为等特殊人群,如出现难以治愈的”霉菌性口炎”或反复发作、原因不明的疱疹性口炎,或出现毛状白斑、卡波济肉瘤等口腔病变,应及时进行HIV检测。     

Oral manifestations in 101 Cambodians with HIV and AIDS.

BACKGROUND: The HIV/AIDS epidemic in Cambodia has become a major problem in the last 7-8 years, mainly because in this formerly war-stricken country the socioeconomic situation is only slowly improving. Since only very few studies have been published to date on the oral health status of Cambodian HIV/AIDS patients, it was the purpose of the present investigation to study oral manifestations in Cambodian patients with HIV disease. METHODS: One hundred one Cambodian patients with HIV infection or AIDS were examined for the presence of oral manifestations in one medical center in Phomh Penh, Cambodia. RESULTS: Sixty-three men and 38 women with a median age of 32 years were examined (age range 7.5-63.5 years). Of these patients, 42.6% were smokers, 46.5% of men were heavy drinkers and 90.5% of men were promiscuous compared with 5.3% of women. The most frequent AIDS-defining diseases were wasting syndrome (54.5%), Pneumocystis carinii pneumonia (PcP) (19.8%) and tuberculosis (18.8%). Puritic papular eruption, a common cutaneous manifestation in HIV-infected patients, was seen in 17.8% of patients. Candida-associated infections of the oral cavity were most common. Among the patients, 52.5% revealed pseudomembranous candidiasis and 35.6% had bilateral hairy leukoplakia. Only 10% of patients had no oral lesions. Also common were necrotising ulcerative gingivo-periodontal diseases (27.7%). CONCLUSION: The general health status of 101 Cambodian patients with HIV infection and AIDS was poor, and they demonstrated a large number of oral manifestations. Antiretroviral therapy is presently not available and only a fraction of patients receives antimycotic treatment (25.7%). HIV infection and the AIDS epidemic in Cambodia have become a serious problem and patients urgently need adequate diagnosis and antiretroviral therapies.     

Oral manifestations in HIV/AIDS infected patients from India

OBJECTIVES: To assess types and prevalence of HIV-related oral lesions among HIV-infected individuals in south India and to correlate common oral findings with co-morbidities, gender, age and medication. SUBJECTS AND METHODS: One hundred and one patients with HIV infection or AIDS at infectious diseases units of Attavar Hospital, Mangalore, and medical wards of Kasturba Medical College, Manipal, were selected. Sociodemographic information was obtained using a structured questionnaire. Oral lesions were diagnosed according to the presumptive criteria of EEC-Clearinghouse Classification. Clinical history was retrieved from patient's medical records. RESULTS: Erythematous candidiasis (44.5%), melanotic hyperpigmentaion (34.6%) and xerostomia (29.7%) were among the most common oral manifestations. A significant association was found between oral candidiasis and advanced immunosuppression (P < 0.05). Oral hairy leukoplakia (OHL) was predominant in individuals <35 years (P < 0.05). Melanotic hyperpigmentation was significantly associated with highly active antiretroviral therapy (P < 0.05). OHL was more frequent in patients with HIV-associated tuberculosis. Linear gingival erythema was more predominant in females. CONCLUSIONS: Oral hairy leukoplakia showed a positive relationship with patients younger than 35 years. Oral candidiasis can act as a marker for immunosuppression. Angular cheilitis was predominant in the symptomatic stage.     

Oral lesions of HIV and AIDS in Asia: An overview

The magnitude of HIV infection in the Asian region is increasing dramatically. Oral disease represents an important health problem for HIV-infected individuals, because of its diagnostic, prognostic and therapeutic implications. The documentation and reporting of HIV infection and AIDS in most of the Asian countries has been superficial. Though the epidemiology of HIV infection in Asia has been studied by many investigators, few attempts have been made to summarise the data and assess the magnitude of the problem, the mode of transmission, the spread of infection and clinical pattern of illness. A review of the literature shows that there is hardly any published data on oral manifestations of HIV infection or AIDS from the Asian region. However, some preliminary information is available on the type of lesion presenting in patients from India and Thailand. These observations suggest that oral manifestations are common in HIV-infected and AIDS patients. The pattern of occurrence of various lesions reported appears to show variation from those reports from other parts of the world, but no definitive conclusion can be drawn from these preliminary observations. Further epidemiological studies are necessary to substantiate the present understanding of the nature of oral lesions found in Asian countries.     

The Oral HIV/AIDS Research Alliance: updated case definitions of oral disease endpoints

The Oral HIV/AIDS Research Alliance (OHARA) is part of the AIDS Clinical Trials Group (ACTG), the largest HIV clinical trials organization in the world. Its main objective is to investigate oral complications associated with HIV/AIDS as the epidemic is evolving, in particular, the effects of antiretrovirals on oral mucosal lesion development and associated fungal and viral pathogens. The OHARA infrastructure comprises: the Epidemiologic Research Unit (at the University of California San Francisco), the Medical Mycology Unit (at Case Western Reserve University) and the Virology/Specimen Banking Unit (at the University of North Carolina). The team includes dentists, physicians, virologists, mycologists, immunologists, epidemiologists and statisticians. Observational studies and clinical trials are being implemented at ACTG-affiliated sites in the US and resource-poor countries. Many studies have shared end-points, which include oral diseases known to be associated with HIV/AIDS measured by trained and calibrated ACTG study nurses. In preparation for future protocols, we have updated existing diagnostic criteria of the oral manifestations of HIV published in 1992 and 1993. The proposed case definitions are designed to be used in large-scale epidemiologic studies and clinical trials, in both US and resource-poor settings, where diagnoses may be made by non-dental healthcare providers. The objective of this article is to present updated case definitions for HIV-related oral diseases that will be used to measure standardized clinical end-points in OHARA studies, and that can be used by any investigator outside of OHARA/ACTG conducting clinical research that pertains to these end-points.     

TRAIL在口腔鳞状细胞癌和白斑中的表达及意义

目的：研究肿瘤坏死因子相关凋亡诱导配体（TNF-related apoptosis inducing ligand,TRAIL）在口腔鳞状细胞癌（OSCC）组织及白斑中的表达及意义。方法：采用免疫组化Maxvision两步法检测54例口腔鳞状细胞癌、30例口腔黏膜白斑、22例正常口腔黏膜组织中TRAIL的表达水平。结果：TRAIL在口腔鳞状细胞癌组织和黏膜白斑中的表达水平均低于其在正常口腔黏膜中的表达水平（P〈0.05）,分别为33.3%、56.7%、86.4%,其在癌组织与白斑中表达水平的差异无统计学意义。TRAIL在高分化癌组织中的表达水平高于中低分化组（P〈0.05）。TRAIL在不同临床分期组间及淋巴结转移与非转移组间表达水平的差异无统计学意义。结论：TRAIL表达的抑制可能与口腔鳞状细胞癌及口腔黏膜白斑的发生有关,并且TRAIL可能参与了初始阶段的正常黏膜向癌组织的转化。TRAIL在口腔鳞状细胞癌中的表达水平与癌组织的分化程度相关。     

Oral manifestations among people living with HIV/AIDS in Tanzania

Background : This study aimed to determine the prevalence of various oral and peri‐oral manifestations in people living with HIV/AIDS in Tanzania. Methods : A cross sectional study. A total of 187 persons with HIV infection were recruited from non‐governmental organisations serving people living with HIV/AIDS, 16.6% were males and females 83.4%. Information on weight and height, as well as extra oral and intra oral examinations for different manifestations were gathered. Treatment and referral for special care were offered. Results : At least one oral lesion was present in 45% of the participants. Candidiasis (28.9%) and non‐tender lymphadenopathy (11.8%) were the most common lesions. Candidiasis occurred most frequently on lips/mucosa, and the tongue, and pseudomembranous candidiasis was the most frequent type. Candidiasis occurred with several other conditions and was statistically significantly associated with low body mass index (BMI). Conclusion : This community survey carried out in an African sub‐Saharan country showed that oral lesions are frequent among people living with HIV/AIDS. As emphasised by the World Health Organization Global Oral Health Programme, national HIV/AIDS programmes should incorporate oral health components.