艾滋病45例病毒基因型耐药检测结果分析

目的观察感染1型艾滋病病毒感染儿童应用高效抗反转录酶疗法治疗过程产生耐药后,行病毒基因型耐药检测对选择新治疗方案的作用。方法对各种治疗失败的艾滋病病例检测与病毒耐药显著相关的病毒反转录酶氨基酸排列突变点位,显示耐药情况。结果艾滋病40例采用一线药物治疗失败。其中14例(35%)出现对核苷类反转录酶抑制剂中原组合应用的齐多夫啶与拉米夫啶同时耐药,26例(65%)对齐多夫啶与拉米夫啶中一种耐药,原核苷类反转录酶抑制剂至少其中的一种仍可应用于新药组合中。对于非核苷类反转录酶抑制剂,11例(27%)对耐韦拉平耐药,29例(63%)对耐韦拉平与艾非那韦同时耐药。5例二线药物治疗失败中,2例中耐药检测结果显示在一、二线药物中各有一药未出现耐药,可在新药物组合中应用。结论基因型耐药检测技术的应用对选择最好的个性化的艾滋病治疗方案有重要意义。     

艾滋病并肺结核患儿的临床及X线特点

目的探讨儿童艾滋病并肺结核的临床及X线特点。方法对已确诊的19例艾滋病并肺结核患儿的临床资料及X 线表现进行分析。结果小儿艾滋病并肺结核最常见的临床表现为咳嗽、长期不规则发热、盗汗和气促。胸部X线多为多发片状阴影、两肺粟粒结节样阴影及肺门纵隔淋巴结大。单发片状阴影常常发展为双侧多发片状阴影。结论小儿艾滋病并肺结核胸部X线多表现为片状模糊阴影,粟粒结节样阴影,肺门纵隔淋巴结大。随访复查X线胸片表现常有发展变化。X线胸片检查对本病诊断起着重要作用。     

Autoimmune phenomena in children with Human Immunodeficiency Virus infection and Acquired Immunodeficiency Syndrome

We have studied sera from 44 children with Human Immunodeficiency Virus infection and Acquired Immunodeficiency Syndrome using immunoblotting, radioimmunoassay, enzymoimmunoassay and indirect immunofluorescence. We have detected a low incidence of antinuclear (2.9%), anti-reticulin (2.9%) and anti-smooth muscle (14.7%) antibodies by indirect immunofluorescence. By enzymoimmunoassay we have detected anti-dsDNA (20.5%) and anti-ENA [anti-nRNP (61.3%), anti-Sm (29.5%), anti-Ro (47.7%) and anti-La (18.1%)] antibodies. Tests for anti-dsDNA by radioimmunoassay were negative, suggesting the presence of low-avidity anti-DNA antibodies. By immunoblotting we have detected anti-C (nRNP) (33.3%), anti-BB' (Sm) (33.3%), anti-Ro (60 KD) (4.5%) and anti-La (11.3%) antibodies. The presence of anti-Ro antibodies was associated with progressive neurological disease. Long-term follow-up studies with larger numbers of patients are necessary to evaluate the clinical significance of the presence of anti-dsDNA and anti-ENA antibodies in children infected with Human Immunodeficiency Virus.     

Adrenal Gland Leiomyoma in a Child with Acquired Immunodeficiency Syndrome

An adrenal gland leiomyoma was incidentally found at autopsy in a 2-year-old boy with acquired immunodeficiency syndrome (AIDS). Smooth muscle neoplasms have been described in pediatric AIDS and affect mainly the tracheobronchopulmonary, gastrointestinal, and hepatobiliary systems. An association between Epstein-Barr virus (EBV) and smooth muscle tumors in patients with AIDS has been described. This case is the first leiomyoma to be reported in the adrenal gland of a child with AIDS. EBV genome was demonstrated in the tumor by polymerase chain reaction.     

高效抗反转录病毒治疗艾滋病患儿近期不良反应71例

目的 观察人类免疫缺陷病毒(HIV)感染者或艾滋病(AIDS)患儿接受联合高效抗反转录病毒治疗(HAART)不良反应的发生情况.方法 71例经酶联免疫法初筛、Western blot法确诊HIV感染、以前未接受过HAART的儿童入选本前赡性队列研究.男49例(69.0%),女22例(31.0%);平均年龄9.2(2～16)岁.其中46例接受齐多夫定(AZT)加拉米夫定(3TC)加奈韦拉平(NVP)治疗,25例接受司他夫定(d4T)加3TC加NVP治疗,记录治疗开始6个月内的不良反应(包括恶心、呕吐、腹泻、腹痛等消化道症状,中性粒细胞、Hb 下降,转氨酶升高,皮疹,血淀粉酶升高等)发生率,并比较2种治疗方案的不良反应.结果 主要不良反应发生情况如下:消化道症状(包括恶心、呕吐、腹泻、腹痛)52例(73.2%)、Hb下降30例(42.3%)、中性粒细胞下降12例(16.9%)、ALT升高15例(21.1%)、皮疹10例(10.4%)和血清淀粉酶升高6例(8.5%),多为轻到中度.Hb下降的发生率AZT加3TC加NVP组(56.5%)显著高于d4T加3TC加NVP组(16.0%)(P=0.001).6例因不良反应而更改治疗方案,其中3例因AZT引起贫血改用d4T,1例因皮疹、2例因ALX升高将NVP改为依非韦仑(EFV).无患者因不良反应而停止HAART.结论 儿童AIDS的HAART近期不良反应较少,程度较轻,耐受性良好.AZT较d4T的骨髓抑制作用明显.实用儿科临床杂志,2009,24(10):780-782     

儿童获得性免疫缺陷综合征临床特点

目的 探讨儿童获得性免疫缺陷综合征(AIDS)的病因、临床特征、诊治经过及预后,以提高对该病的认识.方法 对2001年以来在广西医科大学第一附属医院儿科住院的12例儿童AIDS或疑似AIDS的临床及实验室检查资料进行回顾性分析,以总结其临床特点.结果 12例患儿中男9例,女3例;年龄45 d-9岁;11例患儿父母血清均为人类免疫缺陷病毒(HIV)抗体阳性或疑似因AIDS死亡者;临床表现为生长发育迟缓并不同程度营养不良12例(100%),长期不规则发热、间断性咳嗽及肝脾大各10例(83.3%),迁延性腹泻及淋巴结大各8例(66.7%).全身性皮炎6例(50%),大脑发育不全4例(33.6%),口腔念珠菌感染3例(26.7%),中耳炎2例(16.7%);实验室检查:12例2次血清HIV抗体检测均呈阳性,CD4 T淋巴细胞的百分比均下降,CD4 /CD8 细胞比值均降低,肝功能检查转氨酶均升高,3例血清巨细胞病毒抗体阳性,4例血培养及1例骨髓培养出马尔尼菲青真菌,大便涂片及培养4例找到真菌.死亡1例,余病例对症治疗效果差.结论 儿童AIDS潜伏期相对较短,临床表现多样化,细胞免疫功能低下,对症治疗效果差.提高对该病的认识,可早期诊断、早治疗,延长患儿生命.     

Infections in Children with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: An Autopsy Study of 30 Cases in South Florida, 1990-1993

Thirty autopsies performed on infants and children with HIV infection and/or AIDS were reviewed for the presence and type of infection. Twenty-six (87%) demonstrated evidence of infection in addition to HIV at the time of postmortem examination. Pathogenic bacterial infections were the most frequently encountered, seen in 15 of the cases. Nine of the 15 (60%) were due to gram-negative rods, most commonly Pseudomonas aeruginosa. Infections with gram-negative organisms often involved multiple organ systems and were frequently undiagnosed both pre -and postmortem because of variability in culture results and difficulties in identification both clinically and in tissue sections. Discussion is presented of unusual staining characteristics and filamentous morphology found with these pathogens. Other pathogenic bacteria encountered were Klebsiella pneumoniae, Escherichia coli, Enterobacter sp., and Staphylococcus. Fungal infections due to Candida species were present in nine cases (31 %) but were invasive in only two of these. One instance of Aspergillus meningo-encephalitis was noted. Proven viral infections were present in five children (three cytomegalovirus, one herpes simplex, and one adenovirus). Pneumocystis carinii pneumonia was diagnosed in five of the patients (17%), and one instance of disseminated Mycobacterium avium-intracellulare was encountered.     

获得性免疫缺陷综合征并卡氏肺囊虫肺炎16例

目的探讨获得性免疫缺陷综合征(AIDS)并卡氏肺囊虫肺炎(PCP)的诊断和治疗。方法AIDS并PCP患儿16例。男12例,女4例;年龄6个月~14岁。均有发热、呼吸困难。咳嗽13例,发绀、三凹征、鼻扌扇9例,消瘦、乏力、畏寒、食欲下降5例。体检仅3例肺部闻及少许湿音。结果X线胸片均有改变,且变化较大;11例采用高渗盐水雾化吸入诱导排痰检查涂片5、例经支气管肺泡灌洗液检查而确诊。13例采用复方磺胺甲基异唑50 mg/(kg.d),10例治愈,3例死亡,另3例未治疗死亡。结论AIDS并PCP是AIDS的主要致死原因之一。早期发现、及时治疗可改善预后。     

小儿慢性腹泻病的营养治疗

小儿慢性腹泻病（chronic diarrhea disease，CDD）是导致小儿营养不良的重要原因，而营养不良又常会加重CDD患儿病情，严重影响患儿生长发育，因此若想减轻或避免腹泻引起的营养不良和提高患儿生存质量，合理地作好CDD患儿营养治疗是非常必要和必须的。