HIV阳性与HIV阴性猴痘患者临床特征分析

Clinical characteristic of Mpox with HIV-positive or HIV-negative patients

目的分析人HIV阳性与HIV阴性猴痘患者的临床和影像特征,为临床诊疗提供参考。方法回顾性分析2023年6月1日至11月30日首都医科大学附属北京佑安医院收治住院的36例确诊猴痘患者的临床和影像资料,按照是否合并HIV感染分为HIV阳性组和HIV阴性组。观察比较两组人群临床和影像特征。结果36例猴痘患者均为男性且为男男性行为者(men who have sex with men,MSM),平均年龄(31.5±6.4)岁;HIV阳性组28例,HIV阴性组8例。主要表现为皮疹、发热、淋巴结肿大。皮疹的首发部位(24例,66.7%)和最主要的分布部位(30例,83.3%)均为生殖器和肛门,以丘疹和脓疱疹为主。合并其他性传播性疾病14例(38.9%,14/36);合并细菌感染21例(58.3%,21/36),主要为皮肤软组织感染和肛周感染。影像检查结果异常者均为HIV阳性组患者。4例(11.1%,4/36)肺炎CT表现以磨玻璃影、实变、多发结节为主;2例并发肠梗阻,影像表现以胃肠道扩张为主,2例直肠炎表现为直肠壁增厚,肠腔狭窄。两组患者的流行病学资料、临床特征、皮疹分布及性质和实验室检查结果比较差异均无统计学意义(P>0.05)。结论36例猴痘患者以青壮年MSM人群为主,且多为HIV感染者;生殖器和肛周是皮疹首发和最多发部位,溃疡样皮疹仅见于HIV感染者;轻症患者预后良好,重症患者可合并细菌性感染、肠梗阻和直肠炎。并发肺炎者CT主要表现为实变和磨玻璃影,并可见两肺多发、随机分布的实性结节。

Objective To analyze the clinical and imaging characteristics of Mpox with HIVpositive or HIV-negative patients,so as to provide reference for clinical diagnosis and treatment.Method The clinical and imaging data of 36 confirmed Mpox patients admitted to Beijing You'an Hospital of Capital Medical University from June 1 to November 30,2023,were retrospectively analyzed.The patients were divided into HIV-positive and HIV-negative groups based on whether they were co-infected with HIV.The clinical and imaging characteristics of the two groups were observed and compared.Result All 36 cases were from the male population who have sex with men(MSM),with an average age of(31.5±6.4)years.There were 28 cases in the positive group and 8 cases in the negative group.The most common features were skin lesions,fever,and lymph node enlargement.The rash first appeared on the genitals and anus in 24 cases(66.7%)and was predominantly distributed in those areas in 30 cases(83.3%),with papules and pustules being the most common.There were 14 cases(38.9%,14/36)of comorbidities with other sexually transmitted diseases.Additionally,there were 21 cases(58.3%,21/36)of comorbid bacterial infections,mainly soft tissue skin infections and perianal infections.Patients with abnormal imaging findings were in the HIV-positive group.CT findings four cases of bacterial pneumonia were characterized by ground-glass opacities,consolidations,and multiple nodules.Two cases were complicated by intestinal obstruction,and the imaging features were dominated by dilatation of the gastrointestinal tract.In one case,proctitis was manifested as thickening of the rectal wall.There were no statistically significant differences found between the epidemiological data,clinical characteristics,distribution and nature of the rash,and laboratory test results of the two groups(P>0.05).Conclusion Mpox patients in Beijing are mostly young MSM and are often HIV-positive.The rash typically appears first and most often in the genital and perianal areas.Ulcerative rashes are only observed in individuals who are HIV-positive.Mild cases have a good prognosis,while severe cases can be complicated by bacterial infections,intestinal obstruction,and proctitis.CT in patients with pneumonia shows solid and ground-glass density shadows and multiple,randomly distributed solid nodules in both lungs.