获得性免疫缺陷综合征患者咽喉部病变分析

Analysis on laryngopharyngeal lesions of patients with acquired immune deficiency syndrome

目的探讨获得性免疫缺陷综合征(AIDS)患者咽喉部病变的临床特点。方法以2009年1月至2018年10月因咽喉部疾病且局部有阳性体征就诊于首都医科大学附属北京地坛医院耳鼻喉科的82例AIDS患者为研究对象,分析其咽喉部病变的临床特点。结果入组患者溃疡表现者33例,溃疡发生部位以散在多发为主(10例),其次位于扁桃体(5例),咽后壁(4例),腭咽弓及腭舌弓(各3例),咽侧壁及会厌(各2例),软腭、舌根、声带及劈裂(各1例)。咽喉部表现为急慢性充血、肿胀者21例,有白色菌苔附着者13例。伴新生物表现患者共7例,其中4例患者为卡波氏肉瘤(KS),3例患者为乳头状瘤。声带麻痹者7例,其中6例患者声音嘶哑,1例患者吞咽困难。因免疫重建致扁桃体Ⅲ度肿大者1例。入组82例患者中有79例接受了全身高效逆转录病毒治疗(HAART)或咽喉部疾病局部针对性治疗,其中69例患者行全身HAART治疗,68例行局部的针对性治疗;而3例患者全身HAART及局部针对治疗均未施治。行治疗的79例患者转归:61例治疗有效,14例治疗无效,4例死亡;3例全身及局部均未施治者均无好转。结论AIDS患者咽喉部疾患以溃疡表现为主,溃疡病程久、症状重、易复发、不易治愈,与基础疾病相关;除溃疡性疾病外,还会出现机会性感染及肿瘤。此类疾病的治疗以改善全身免疫状态为主,局部对症治疗为辅。

Objective To investigate the clinical characteristics of laryngopharyngeal diseases of patients with acquired immune deficiency syndrome(AIDS).Methods Data of 82 patients with AIDS who were complicated with laryngopharyngeal diseases and locally positive signs in Department of Otolaryngology,Beijing Ditan Hospital,Capital Medical University from January 2009 to October 2018 were collected.The clinical characteristics of laryngopharyngeal diseases of these cases were analyzed and summarized.Results There were 33 cases with ulcer manifestations,which developed mainly at multiple sites(10 cases),and following by tonsil(5 cases),posterior pharyngeal wall(4 cases),palatopharyngeal arch(3 cases),palatoglossal arch(3 cases),ateral pharyngeal wall(2 cases),epiglottis(2 cases),soft palate(1 case),lingual root(1 case),vocal cord(1 case)and splitting(1 case).There were 21 cases with acute and chronic congestion and swelling in pharynx and larynx and 13 cases with white fungus moss attachment.There were 7 cases with new biological manifestations,including 4 cases with Kaposi’s sarcoma(KS)and 3 cases with papilloma.There were 7 cases with vocal cord paralysis,including 6 cases with hoarseness and 1 case with dysphagia.One case were found tonsillar gradeⅢenlargement due to immune reconstruction.Among the 82 patients,79 patients were treated with systemic highly active antiroviral therapy(HAART)or local targeted treatment of throat diseases,69 of whom were treated with systemic HAART and 68 cases were given local targeted treatment;while 3 patients without systemic HAART or local treatment.Results of 79 patients with treatment were 61 cases with effective,14 cases with ineffective and 4 cases died.Three cases without systemic or local treatment did not get better.Conclusions The laryngopharyngeal diseases of AIDS patients are mainly ulcer,which has a long course,with severe symptoms,easy recurrence,difficult to cure and related to basic diseases;besides ulcerative diseases,opportunistic infections and tumors could also be found.Treatment of such diseases is mainly to improve the immune status,supplemented by symptomatic treatment.