21例HIV/AIDS合并带状疱疹患者的临床护理

艾滋病即获得性免疫缺陷综合征（AIDS）是由人类免疫缺陷病毒（HIV）引起的一种严重传染病，目前尚无特效治疗方法，病死率极高。由于HIV病毒侵犯机体免疫系统，大量杀伤免疫细胞，使机体免疫功能缺陷及免疫监督功能降低，易并发许多机会性感染。     

病毒逃逸免疫防卫机制及可能对策

病毒逃逸免疫的一种典型方式是以潜伏形式存在于宿主细胞内或整合于细胞ＤＮＡ中,对抗免疫清除。一旦机体免疫功能低下,则又活化,复制成感染性病毒而致病。疱疹病毒家族成员中,包括单纯疱疹和带状疱疹病毒、巨细胞病毒（ＣＭＶ）,ＥＢ病毒（ＥＢＶ）及Ｋａｐｏｓｉ肉...     

HIV感染者和艾滋病患者HAART治疗后发生不和谐反应的影响因素研究进展

人类免疫缺陷病毒（HIV）感染者和艾滋病患者经高效抗反转录病毒治疗（HAART）后,部分患者出现不和谐反应,即HIV RNA低于检测下限,但其CD4 ＋ T细胞数并没有显著增长;或是以CD4 ＋ T细胞数升高,但HIV病毒持续未降至检测下限以下为特征的另一种形式的不和谐反应.此类患者的病死率较免疫完全应答的患者显著升高.然而,对导致这些患者免疫功能不能完全重建的具体机制尚不明了.该文从病毒、免疫、宿主等方面对HIV感染者和艾滋病患者经HAART治疗后不和谐反应的研究进展予以综述.     

婴儿巨细胞病毒肝炎的诊断与治疗策略

婴儿巨细胞病毒肝炎是我国婴儿常见的一种肝脏疾病。诊断该病必须具备活动性巨细胞病毒（CMV）感染的实验室依据及参考患儿月龄、免疫功能状态。目前国内外尚无标准的治疗方案,临床实践发现使用更昔洛韦分为诱导治疗和维持治疗两个阶段较好,疗程视病情而定,治疗过程中需监测药物不良反应;中医药治疗CMV感染疗效较好、无明显毒副作用,现就其诊断及治疗进度综述如下。     

系统性红斑狼疮并发带状疱疹后创面感染的护理简

系统性红斑狼疮（systemiclupuserythematosus,SLE）是一种能损害多器官的系统自身免疫疾病,现阶段尚无根治方法。现临床主要采用糖皮质激素和免疫抑制剂治疗。带状疱疹是临床较为常见的一种皮肤病,临床表现为神经痛、局部神经受累、黏膜和皮肤上发生丘疱疹或者疱疹,主要发病原因是带状疱疹病毒,常会发生在患有SLE等免疫力低的人群中,而长期接受免疫抑制剂和糖皮质激素治疗的患者也容易出现带状疱疹,     

上皮细胞内在固有免疫在EBV相关肿瘤中的作用研究进展

EB病毒（Epstein-Barr virus,EBV）是人类发现的第一种肿瘤相关病毒,与鼻咽癌、胃癌、肺淋巴上皮样癌和几种淋巴瘤的发生和发展密切相关。在EB病毒阳性的实体瘤中,肿瘤免疫微环境的特征及上皮细胞内在固有免疫在其中发挥重塑的作用机制尚未阐明,当代免疫检查点抑制剂治疗在病毒相关性肿瘤中初步取得了良好效果。本文重点综述EBV感染细胞的机制、EBV阳性实体瘤中细胞内在固有免疫的变化及免疫检查点抑制剂在EBV相关肺癌等肿瘤中的应用进展。     

乙型病毒性肝炎临床检验结果的临床意义

乙型病毒性肝炎（hepatitis B victims,HBV）是所有肝炎中发病率最高,对人类健康危害最大,最为严重的一种肝炎.HBV是一种脱氧核糖核酸病毒,完整的病毒颗粒称为Dane颗粒,分为外壳和核心两部分,外壳是表面抗原（HBsAg）,核心部分有核心抗原（HBcAg）,e抗原（HBeAg）,基因组由部分双链环状DNA组成.主要经过血液、密切的日常生活接触和母婴垂直传播.临床上常用的检测方法为酶联免疫法（ELISA）、金标免疫层析法和放射免疫法.本文就以上所涉及的几个问题进行综述.     

干扰素治疗慢性乙型肝炎副作用的观察与护理

我国是病毒性肝炎高发地区,慢性乙型肝炎是我国的常见病。干扰素（IFN）是一种具有抗病毒和调节免疫作用的生物活性物质,是目前临床用于治疗慢性乙型肝炎的主要药物之一,但在治疗的过程中,多数患者出现流感样症状、疲劳等副作用。     

局部免疫调节剂咪喹莫特对尖锐湿疣患者皮损处HPV病毒DNA含量的影响

目的 了解局部免疫调节剂与全身免疫调节剂在治疗尖锐湿疣（CA）患者时对皮损处HPV病毒DNA含量的影响.方法 采用PCR技术分别检测局部免疫和全身免疫治疗的尖锐湿疣患者治疗前后同一部位HPV病毒含量;再进行比较,观察两种治疗方法对HPV病毒DNA含量的影响.结果 局部和全身免疫治疗对患者病损局部的病毒DNA含量均有不同程度的减少作用,其中以局部免疫剂对其含量的减少幅度较大,两者比较有统计学意义.结论 局部免疫调节剂的局部抗病毒效果优于常规的全身治疗.     

T淋巴细胞与炎症性肠病

T淋巴细胞是具有特异性免疫功能的一种白细胞,它接受抗原刺激变成致敏细胞后乃分化繁殖成具有免疫活性的细胞,其免疫作用包括排斥移植来的异体组织、破坏肿瘤细胞、抑制病毒与细胞繁殖等。炎症性肠病（IBD）是一种病因尚不十分清楚的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎（UC）和克罗思病（CD）。炎症性肠病与自身免疫密切相关,T淋巴细胞在其发生发展中发挥重要的作用。     

Renal graft dysfunction during infection with cytomegalovirus: association with IgM lymphocytotoxins and HLA-DR3 and DR7

Of 121 consecutive adult recipients of cadaver renal transplants who were treated with low dose steroids and azathioprine, 23 developed active cytomegalovirus infections. These 23 patients were divided into three groups on the basis of their symptoms related to the infection: five patients had no renal, respiratory, or haematological abnormalities; seven had renal dysfunction; and nine had renal dysfunction plus respiratory or haematological abnormalities. Two patients were regarded as a separate group because their infections occurred two to four weeks after graft nephrectomy. All but three of the patients produced IgM or IgG lymphocytotoxins during their infections. In the patients with mild infections and in control patients without infections, however, these lymphocytotoxins were predominantly IgG antibodies that were not precipitated by 3.5% macrogol (polyethylene glycol). In contrast, 12 of the 16 patients with renal dysfunction during their infections had broadly reactive IgM lymphocytotoxins. These IgM lymphocytotoxins lysed T as well as B lymphocytes at 22 degrees C and were precipitated by 3.5% macrogol, suggesting that they were circulating as immune complexes. Rheumatoid factors were found in sera from nine patients with cytomegalovirus infections, seven of whom developed leukopenia or pneumonia, or both, in addition to renal dysfunction. Some of these immune responses associated with cytomegalovirus infection in transplant recipients may be genetically controlled since 10 of 11 patients positive for HLA-DR3 or DR7 produced IgM lymphocytotoxins.     

Human herpesvirus 6 infection in transplantation

Human herpesvirus 6 (HHV-6) is ubiquitous in the human population and causes exanthem subitum, a benign disease seen in infancy. The virus remains latent in the body after primary infection, and reactivates in immunocompromised patients. Infection occurs in nearly half of all bone marrow or solid organ transplant recipients 2-3 weeks following the procedure. It has been suggested that the viral infection and activation result in clinical symptoms including fever, skin rash, pneumonia, bone marrow suppression, encephalitis, and rejection. In order to control the viral infection, several studies investigating the route of viral transmission and diagnostic procedures have been carried out.     

人类微小病毒B19感染的最新进展

人类微小病毒B19主要侵袭人体骨髓造血系统,损害人体多种脏器,是儿科出疹性疾病——传染性红斑的病原。还可使慢性溶血患者发生再障危象、关节病、血管性紫癜和雷诺肢端综合征等。在免疫缺陷患者,可造成持续感染。妊娠期受到病毒侵害,引发宫内感染,可导致流产、胎儿水肿和死胎。此外,还与多种造血系统异常(中性粒细胞减少症和血小板减少症等)有关。     

甲型H1N1肺炎的影像学特征

目的 探讨甲型H1N1病毒所致肺炎的影像学特征。方法 回顾性分析27例经实验室证实的甲型H1N1肺炎患者的胸部X线及CT影像学表现。结果 按照甲型H1N1病毒肺炎的受累面积,将27例患者按初诊时肺部的影像改变程度分为轻、中、重度3种类型。轻度者10例,表现为散在分布的、斑片状磨玻璃样阴影;中度者9例,表现为双肺散在分布的、多发片状实变阴影及结节影,5例合并胸腔积液,并伴有轻、中度代偿性肺气肿;重度者8例,表现为双肺大片实变阴影伴有空洞,其中2例合并霉菌球,3例伴有支气管扩张,4例合并纵隔及胸壁皮下气肿,均伴有双侧胸腔积液及中、重度肺气肿。6例死亡病例中,1例为轻度肺炎恶化死亡,1例为中度肺炎转化为重度肺炎后死亡,其他4例为重度肺炎病例。结论 甲型H1N1肺炎表现为多肺段受累的磨玻璃样变和实变,重度者常伴有空洞、支气管扩张、胸腔积液、纵隔皮下气肿及霉菌感染,死亡率高。     

儿童重症肺炎支原体肺炎的临床特点及影像学表现分析

目的总结分析儿童重症肺炎支原体肺炎的临床特点和影像学表现。方法收集2016年6月至2018年6月入院就诊的重症肺炎支原体肺炎患儿60例作重症组,同时选取同期65例轻症肺炎支原体肺炎患儿作轻症组,对比两组患儿的临床表现、体征、实验室检测指标等临床资料,并分析重症肺炎支原体肺炎患儿影像学表现的特点。结果与轻症组相比,重症组患儿临床特点以心动过速、大环内酯类抗生素治疗无效、平均热程长为主,病变特点以大片状阴影为主,重症组患儿血清中CRP、D-二聚体水平显著增加(P<0.05),并出现肺不张、胸腔积液、坏死性肺炎或肺脓肿等肺内并发症,还会累及呼吸、神经、血液、消化、泌尿等系统出现功能障碍;同时,随访发现重症组患儿转归情况明显差于轻症组;典型重症肺炎支原体肺炎影像学显示患儿症状好转后,仍存在肺组织结构的损伤。结论重症肺炎支原体肺炎儿童临床表现为:症状重、发热时间长、肺部出现大片状阴影,易发生肺内并发症,且伴有明显其他系统功能受损,及时干预控制病情,有助于患儿早日康复,且需要长期随访观察其预后。     

巨细胞病毒肺炎6例临床分析

目的探讨巨细胞病毒（CMV）肺炎的临床特点与诊疗措施。方法采用回顾性调查的方法对6例巨细胞病毒肺炎的临床资料进行分析。结果该组6例CMV肺炎患者均出现发热、咳嗽，伴有不同程度的呼吸困难等症状，血气分析均提示严重的缺氧，PO：明显降低；肺CT均显示双肺弥漫分布磨玻璃样阴影。更昔洛韦抗病毒，丙种球蛋白及甲强龙治疗，6例患者中3例死亡，3例存活。结论CMV肺炎常发生于恶性肿瘤大剂量化疗后、器官移植术后应用免疫抑制剂的患者，早期的诊断和及时有效的治疗是降低死亡率的关键。应停止化疗或减撤免疫抑制药物，给予有效的抗病毒治疗，对病情恶化、发生呼吸衰竭的患者应用呼吸机辅助呼吸。     

Systemic cytomegalovirus infection complicating ulcerative colitis: a case report and review of the literature

Cytomegalovirus is a common infection worldwide and in the immunocompromised individual it can be a major cause of morbidity and mortality. In patients with inflammatory bowel disease cytomegalovirus infection has been described in both immunocompetent and immunocompromised individuals. A 34 year old man with an exacerbation of his colitis was diagnosed as having both cytomegalovirus colitis and hepatitis. The diagnosis was made on the classical appearance of "owl's eye" inclusion bodies on colonic and hepatic biopsies and, in addition, viral serology and polymerase chain reaction (PCR) analysis of the cytomegalovirus DNA copy number. Fourteen days of treatment with ganciclovir led to a prompt improvement in the symptoms of colitis, resolution of the pyrexia, normalisation of the liver function tests, and clearance of the virus, as measured by a negative cytomegalovirus DNA PCR. Cytomegalovirus infection is a potentially fatal complication of treatment induced immunosuppression in patients with inflammatory bowel disease. As in this case, infection may be systemic and not confined to the intestine. Prompt diagnosis using histology, serology, and PCR analysis allows prompt introduction of therapy and an improved prognosis.     

免疫抑制后肺部机会性感染的影像诊断

艾滋病的流行、器官移植、免疫抑制剂的大量使用均可导致病人的免疫系统严重受损，而并发肺部机会性感染是这些免疫抑制病人的主要临床问题。影像在诊断和治疗这类病人中起着重要作用。本文主要讨论肺部机会性感染的胸片及CT诊断。肺部机会性感染是HIV／AIDS的主要并发症，由多种病因引起。成人HIV／AIDS肺部感染最常见的类型为肺结核、肺孢子虫肺炎和细菌性肺炎。由于抗排异反应药物及免疫抑制荆的应用，导致器官移植的病人机体免疫功能严重受抑，最主要的病因是巨细胞病毒。侵袭性霉菌病几乎都发生在白细胞严重减少的免疫抑制病人。慢性疾病病人免疫中度受损时，易发生特有的霉菌病，称半侵袭盛慢性坏死性霉菌病。在肺部机会性感染病人的诊断和治疗中，放射科医生起了很重要的作用。然而影像学表现都不具特异性，但合理选择成像方法，密切结合临床和流行病学等对肺部机会性感染的诊断、病情评估和预后具有重要意义。     

Severe haemolytic anaemia due to cold anti-'i' antibodies associated with cytomegalovirus infection.

A 66 year old patient with multiple myeloma and monoclonal cryoglobulinaemia who developed a severe haemolytic anaemia following a cytomegalovirus infection is reported. The presence of a high titre of anti-''i'' cold antibody of IgM subclass is demonstrated. Anti-''i'' antibody disappeared when complement-fixation antibody titres against cytomegalovirus decreased. Various pathogenetic mechanisms involved in the development of haemolytic anaemia associated with cytomegalovirus infection are discussed. To our knowledge, this is the first case described in the English language publications associating severe haemolytic anaemia with an anti-''i'' antibody after a cytomegalovirus infection in an immunocompromised patient.     

Cytomegalovirus colitis with a new diagnosis of ulcerative colitis in an elderly woman

Objectives: Cytomegalovirus (CMV) colitis is generally diagnosed in immunocompromised patients. It is rare for patients who are not immunocompromised to develop CMV colitis. Cases of CMV colitis in patients with inflammatory bowel disease have also been reported. We encountered a case of CMV colitis with a new diagnosis of severe ulcerative colitis and demonstrated the importance of suspecting ulcerative colitis in immunocompetent patients with CMV colitis.Patient: A 78-year-old woman was hospitalized with fever and diarrhea that had lasted for a month. Colonoscopy revealed continuous diffuse edema, mucosal redness, and multiple punched-out ulcers with bleeding, suggesting cytomegalovirus (CMV) colitis, although she was not immunocompromised. Immunohistochemical staining revealed CMV-positive cells, and CMV colitis was diagnosed. One month later, a colonoscopy was conducted owing to persistent symptoms despite initiating the prescribed antiviral drug. A complete loss of vascular pattern, easy bleeding of the crude mucosa, and exacerbation of multiple punched-out ulcers were observed. She was diagnosed with severe ulcerative colitis. The symptoms of ulcerative colitis disappeared with prednisolone and 5-amino salicylic acid treatment.Conclusion: Ulcerative colitis should be suspected in immunocompetent patients with CMV colitis.