儿童艾滋病三例分析

Clinical manifestations of 3 cases with AIDS in children

目的 报道 3例儿童艾滋病 ,以提高对儿童艾滋病的认识。方法 1999年 1月～ 2 0 0 1年 7月 ,北京儿童医院收治的 3例艾滋病患儿均经免疫层析法、酶联免疫ELISA双抗原夹心法筛查及蛋白印记法确认抗人类免疫缺陷病毒 (HIV)抗体阳性 ,诊断为艾滋病。结果 3例中男性 2例 ,女性1例 ,年龄为 4～ 6岁 ,均以长期反复咳嗽为主诉 ,病史长达 3个月至 2年 ,全身临床表现有长期间断发热 (3例 )、明显消瘦 (3例 )、慢性腹泻 (2例 )等。在身体各器官中 ,以肺、脑、肾的表现较为突出 :肺部以反复急、慢性感染为主要表现 ,X线及CT表现各异。 2例头颅CT示脑萎缩 ,其中 1例程度较重 ,临床表现为明显的智力发育落后及进行性运动退化 ;2例有肾脏改变 ,1例为双肾弥漫性纤维化 ,另 1例表现为双肾饱满、尿检异常。 1例合并有丙肝病毒感染 ,但肝功能正常。实验室检查 3例均显示不同程度的贫血和免疫功能低下 ,尤其以CD4明显降低为主要特点。 3例中 2例有多次输血史 ,1例的父母为HIV感染者。该 3例入院后曾被诊断为反复呼吸道感染、营养不良、免疫缺陷病等 ,因怀疑艾滋病而做HIV抗体检测 ,确诊为艾滋病 ,即转送到北京市佑安医院进一步治疗。结论 提高对儿童艾滋病的认识 ,重视影响感染及发病的危险因素 。

Objective To increase the awareness of acquired immunodeficiency syndrome (AIDS) in children. Methods Three cases with serologically confirmed AIDS in children seen between January 1999 to July 2001 were analyzed. The diagnosis of the 3 cases was confirmed by demonstrating presence of HIV antibodies using immunochromatography, a double antigen 'sandwich' enzyme linked immunosorbant assay (ELISA) screening and Western blotting. Results Of the 3 cases, 2 were male and one was female, the age of the patients was 4 6 years. The complaint of all the 3 patients was long term, recurrent cough; the course of the disease before hospitalization was 3 months to 2 years. Systemic clinical manifestations included prolonged intermittent fever (3 cases), marked weight loss (3 cases), chronic diarrhea (2 cases) etc. Among the organ systems of the body, the lung, brain and kidney were the organs predominantly invovlved; the main clinical manifestations of the lung were resurrent acute or chronic infections with various X ray and CT findings; brain CT showed cerebral atrophy in 2 cases, one of whom had remarkable mental retardation and progressive motor disturbances; two cases had renal involvements, one had bilateral diffuse fibrosis of the kidney, the other had mild enlargement of the kidney and abnormal results of urinalysis. One of the cases had concurrent hepatitis C virus infection with normal liver function tests. Laboratory tests showed that all the 3 cases had anemia and decreased immune functions of different degrees, esp. reduced CD + 4 T cells. Two of the 3 cases had a history of multiple transfusion and the remaining one′s parents were both HIV infected. Conclusions AIDS has become a severe threat to children′s health in China. Chinese pediatricians should improve the awareness of AIDS in children, be alert to the risk factors for development of HIV infection and morbidity of AIDS. For suspected HIV/AIDS cases, serum HIV antibodies should be checked as soon as possible.