HIV感染合并肺栓塞2例报道及文献复习

Case report and literature review of 2 patients with HIV infection complicated with pulmonary embolism

HIV感染是严重影响人类健康的慢性传染性疾病之一,肺栓塞(pulmonary embolism,PE)是由于内外源性的栓子堵塞肺动脉主干或分支引起肺循环障碍的一种致死性疾病。HIV感染者合并PE并不常见,但因其病死率高而受到重视。因此,本文回顾了2例HIV感染者合并PE的临床资料,以期提高对该疾病的认识、重视和诊治水平。此2例男性患者年龄均大于40岁,有长期吸烟史,已规律抗HIV治疗,入院后诊断为重症肺炎、呼吸衰竭等,需长期卧床休息,经抗感染等综合治疗后,喘累、气促等症状改善不明显,随后行胸部影像学检查确诊PE,予以抗凝等综合治疗后好转出院。因HIV感染者免疫力低下,易同时合并其他机会性感染,从而忽视PE的胸痛、咯血、呼吸困难等典型的临床症状,导致临床漏诊、误诊。通过本文的病例报道及相关文献的复习,以提高临床医生对本病的认识,对于存在PE高危因素的患者提高警惕,做到早诊断、早治疗。

Human immunodeficiency virus (HIV) infection is one of the chronic infectious diseases that seriously affect human health.Pulmonary embolism (PE) is a fatal disease caused by the blockage of the main or branches of the pulmonary artery by internal and external emboli.PE is not common in HIV-infected people,but it has attracted attention because of its high mortality rate.In this paper,the clinical data of 2 cases of HIV infection combined with PE were discussed in order to improve the understanding,attention and diagnosis of the disease.The two male patients were all over 40 years old,had a long history of smoking,had regular anti-HIV treatment,and were diagnosed with severe pneumonia and respiratory failure after admission,requiring long-term bed rest.After comprehensive treatment such as anti-infection,symptoms such as wheezing and shortness of breath did not improve significantly,and then chest imaging examination was performed to confirm PE,and comprehensive treatment such as anticoagulation was given.Due to the low immunity of HIV infected persons,they are easy to combine with other opportunistic infections,thus ignoring the typical clinical symptoms of PE chest pain,hemoptysis,and dyspnea,resulting in clinical missed diagnosis and misdiagnosis.Through the review of the case report and related literature in this paper,to improve the clinician's understanding of the disease,for patients with PE high risk factors to be vigilant,timely elimination,early diagnosis,early treatment.