以消化系统症状为主要表现的HIV感染者与艾滋病患者27例分析

Analysis on 27 HIV/AIDS cases with gastrointestinal symptoms as major symptom

目的探讨以消化系统症状为突出表现的HIV感染者和艾滋病患者的临床特点,为其早期正确诊治提供依据。方法对2004年2月～2011年2月中南大学湘雅医院消化科收治住院的27例HIV/AIDS患者的临床资料进行回顾性分析。结果 HIV/AIDS患者以农民、无业青壮年男性居多,传播途径以性传播(77.8%)为主。最常见的症状体征为消瘦(100.0%)、纳差(100.0%),其次有贫血(77.8%)、腹泻(63.0%)、发热(55.6%)、腹痛(59.3%)、淋巴结肿大(37.0%)等。门诊误漏诊24例,占88.9%,外院误漏诊率达100%。实验室检查:淋巴细胞减少者占77.8%,血清白蛋白降低者占88.9%,血沉加快者占88.9%。胃镜检查11例,发现念珠菌性食道炎4例(36.4%),肠镜发现结肠黏膜病变者占80.0%。最常见的机会性感染为结核病(37.0%),消化道真菌感染(29.6%),混合感染两种或以上病原体者占40.7%。结论消化系统是艾滋病常见的累及部位,临床医师应提高对以消化系统症状为突出表现的HIV/AIDS的认识,做到早期诊治,避免漏诊、误诊及交叉感染。

[ Objective ] To analyze the epidemiological and characteristics of HIV/AIDS patients with gastroin- testinal symptoms as major symptom so as to provide evidence for early diagnosis and therapy. [Methods] The epi- demiology, clinical manifestations and AIDS-related complications of the 27 inpatient cases were retrospectively an- alyzed. [Results] Young and middle-aged males who was farmers or without work constituted the main part of HIW AIDS patients. The main transmission route was sexual contract （77.8%）. The most common symptoms were weight loss （100.0%）, anorexia （100.0%）, followed by anemia（77.8%）, diarrhea （63.0%）, fever（55.6%）, stomachache （59.3%）, and lymphadeneetasis （37.0%）. The number of misdiagnosed cases in Xiangya hospital was 24 （88.9%）, and the mis- diagnosis rate of other hospitals reached 100%. Lymphoeytoponia was found in 21 cases （77.8%）, hypoproteinemia in 24 cases （88.9%）, and ESR increased in 24 cases （88.9%）. About 36.4% patients who accepted gastroscopy were found mycotic esophagitis, and 80.0% patients were found to have colonic lesions by enteroscopy. The most common opportunistic infection was tuberculosis （37.0%）; gastrointestinal fungal infections in 8 cases （29.6%）; 11 cases （40.7%） mixed infection of two or more pathogens. [ Conclusion ] Digestive system is the main lesion in HIV infec- tion. Clinicians should improve the understanding of HIV/AIDS with gastrointestinal symptoms as major symptom so as to find and cure the patients earlier, avoid missed-diagnosis and cross-infection.