巨细胞病毒性视网膜炎

巨细胞病毒(cytomegalovirus,CMV)性视网膜炎是人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染／获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS,艾滋病)患者最常见的眼部机会性感染,是HIV相关性眼病引起视力丧失的最主要原因,多发生于CD4^ T淋巴细胞计数＜50／mm^3的患者。本文就CMV视网膜夹的发病情况、临床特点、并发症、鉴别诊断和治疗的研究进展进行综述。     

获得性免疫缺陷综合征患者的肺部感染

目的: 提高对获得性免疫缺陷综合征(AIDS)肺部机会性感染的认识。方法: 对18例AIDS患者进行临床分析。结果: 18例患者肺部感染临床症状有发热、消瘦、乏力、咳嗽、咳痰等。卡氏肺囊虫肺炎(PCP)9例;细菌性肺炎7例;霉菌性肺炎6例;肺结核5例;伴有其他多系统感染8例。结论: 肺部感染是AIDS患者晚期的主要机会性感染,其中PCP和细菌性肺炎最多,其次为霉菌性肺炎和肺结核,同时常伴有多系统损害。     

Cytomegalovirus retinitis in patients with acquired immune deficiency syndrome

Cytomegalovirus (CMV) retinitis is the most common intra-ocular infection in patients with acquired immune deficiency syndrome (AIDS), and a leading cause of AIDS-related morbidity. Untreated CMV retinitis in AIDS patients is a progressive and potentially blinding disorder. The diagnosis of CMV retinitis is a clinical one and it is important for physicians to be familiar with the clinical features of the disease. Ophthalmic screening of AIDS sufferers should be undertaken at regular intervals, and this is dictated, in part, by the patient's CD4+ T-lymphocyte (CD4) counts. CMV retinitis may be treated with systemic ganciclovir, foscarnet or cidofovir, or with local (intravitreal) therpy. CMV-related retinal detachment is treated surgically. In some patients with quiescent CMV retinitis receiving highly active anti-retroviral therapy, anti-CMV maintenance therapy may be discontinued in favour of close ophthalmologic observation and CD4 count monitoring.     

艾滋病合并恶性肿瘤10例临床病理分析

目的:分析艾滋病(AIDS)合并恶性肿瘤的临床与病理特点。方法:对会诊和复查的48例AIDS患者的病理活检与尸检材料进行临床、影像、解剖与病理对照研究。结果:48例AIDS患者中合并恶性肿瘤10例;其中儿童2例系母婴传播;成年人8例中经输血传播4例。合并非霍奇金淋巴瘤4例,乳腺癌2例,卡波西肉瘤1例,肝母细胞瘤1例,食管癌1例,肾癌1例。结论:AIDS患者易合并恶性肿瘤,疾病谱广泛,以淋巴瘤多见,确诊需依赖病理检查。     

Fighting against acquired immunodeficiency syndrome with Chinese medicine: A perspective from China

Continuing expansion of the human immunodeficiency virus(HIV)/ acquired immunodeficiency syndrome(AIDS) pandemic has been recognized as an exceptional challenge to global health.Taking highly active antiretroviral treatment (HAART),a confirmed effective treatment,has its limitations.While a much cheaper and potential treatment—the Chinese medicine(CM) has not been paid enough attention from the worldwide.We explained the CM viewpoints about pathology and etiology to answer some questions about whether and how CM can treat AIDS. Some herbal formulae and their targeted patterns and common symptoms were also introduced.Chinese government has realized the important role of CM as an independent therapy for early management,bolstering immune-system functions depressed by HIV,and has funded large randomized double-blind controlled clinical trials to more accurately assess the benefits,and valued the fundamental research to establish a quantitative standardization of pattern diagnosis.Researchers of CM are looking for cooperation with all the world’s top experts in the areas of AIDS and immunity to strive for victories in the fight against AIDS.     

Disseminated Penicillium marneffei infection in acquired immunodeficiency syndrome: a case report

Penicillium marneffei(P.marneffei) is a facultative intracellular pathogen and the only therrmally dimorphic fugus. This fungal intection is cormmonly found in Southeast Asian,     

获得性免疫缺陷综合征的肺部病变：151例尸检材料病理学研究

研究纽约ＭｏｕｎｔＳｉｎａｉ医学中心１５１例尸检材料的肺部病变，旨在概括艾滋病患者肺剖病学的频谱及其病理特征，所有病例均按常规解剖、取材、福尔马林固定，石蜡包埋，苏木素伊红染色。必要时作组织化学染色和免疫组化研究。     

右美托咪定在艾滋病患者肛周手术后镇痛中的临床效果

目的 观察右美托咪定(dexmedetomidine, DEX)在艾滋病(acquired immunodeficiency syndrome, AIDS)患者肛周手术后患者自控静脉镇痛(patient controlled intravenous analgesia, PCIA)中的临床效果。方法 择期在腰硬联合麻醉下行肛周手术的AIDS患者90例,采取随机数字法分为观察组(O组)和对照组(C组)。O组PCIA采用舒芬太尼1.5μg/kg+DEX 2.5μg/kg+氟比洛芬酯200 mg+昂丹司琼8 mg,生理盐水稀释至200 mL,背景剂量为3 mL/h,每次追加剂量为3 mL/h,锁定时间15 min,持续输注48 h。C组PCIA不使用DEX,其余同O组。记录患者术后4、12、24、48 h静息状态下疼痛程度、镇静情况及PCIA追加药物情况,观察两组患者麻醉前、术后24、48 h血浆T淋巴细胞亚群的变化,并记录围术期不良反应发生情况及患者满意度。结果 与C组相比,O组术后各时点疼痛评分降低,PCIA累计追加药物次数明显减少,患者满意度提高(P<0.05),但两组间术后镇静...     

从 艾 滋 病 的 发 现 和 研 究 进 展 看 罕 少 疾 病 研 究 的 意 义

目的 探讨艾滋病的发现和研究进展对罕少疾病研究的意义。方法 回顾艾滋病和艾滋病毒发现历史与研究进展方面的献，并进行分析归纳。结果 艾滋病的发现和命名是从早期报告的一些罕少病例中归纳出来的，早期艾滋病病例具有某些特定的易感因素、免疫缺陷的病理基础1继发某些罕见的机会性感染和肿瘤、高死亡率的共性，由艾滋病毒感染引起，可能起源于非洲，现已播散至全球。结论 人们对疾病的认识一般从罕少病例的报道和研究开始，随着相同病例的积累，才能逐步认识其本质，完善其防治措施。     

建筑工地农民工艾滋病和性传播疾病健康教育效果评价

目的了解健康教育对改变建筑工地农民工艾滋病和性传播疾病相关知识、态度、行为的效果。方法采取整群随机抽样方法,对上海市某区3个建筑工地的1 031名男性农民工实施艾滋病和性传播疾病防治的健康教育,评价健康教育的效果。结果健康教育后农民工对艾滋病和性传播疾病相关知识的知晓率均较教育前显著上升(P<0.001),其中对艾滋病三大传播途径(性传播、血液传播和母婴传播)和非传播途径的知晓率也有显著上升,提高程度最高的是对"窗口期无法检测到抗体""性传播疾病和艾滋病的关系""避免婚前性行为可以预防性传播疾病"知识的知晓率;经健康教育后,对婚前性行为和艾滋病患者的态度有显著改变,49.4%的被调查者选择对艾滋病病毒感染者不会避而远之,64.5%的被调查者认为艾滋病病毒感染者或患者应该象正常人一样生活和工作;行为调查发现,健康教育后肯定使用安全套的概率上升至54.9%;上述态度和行为改变与健康教育前比较差异均有统计学意义(P<0.01)。结论健康教育是提高农民工有关艾滋病和性传播疾病知识、改变其相关态度的有效手段。     

1990—2019年中国人类免疫缺陷病毒/获得性免疫缺陷综合征流行趋势及疾病负担

目的 分析1990—2019年中国人类免疫缺陷病毒/获得性免疫缺陷综合征(HIV/AIDS)疾病流行现状、负担及危险因素变化趋势,预测2020—2030年HIV/AIDS发病和死亡情况。方法 探讨1990—2019年中国HIV/AIDS疾病的流行现状,通过Joinpoint回归拟合其发病率和疾病负担变化趋势。采用集成嵌套拉普拉斯近似(INLA)的贝叶斯年龄-时期-队列分析(BAPC)方法预测2020—2030年HIV/AIDS发病和死亡趋势。结果 1990—2019年中国男性HIV/AIDS标化发病率、标化死亡率高于女性,15～19岁、20～24岁标化发病率总体呈增长趋势,75～79岁标化发病率变化幅度最大。1990—2019年中国HIV/AIDS标化发病率、标化伤残调整寿命年(DALYs)率均呈上升趋势,差异具有统计学意义(P均<0.001);归因于危险性行为的标化DALYs率最高。BAPC预测结果显示,2020—2030年中国男性HIV/AIDS标化死亡率呈上升趋势。结论 中国青少年HIV/AIDS发病风险持续增加,老年群体死亡风险也不容忽视;HIV/AIDS疾病负担呈上升趋...     

高中生预防艾滋病量表的信度和效度分析

目的考察高中生预防艾滋病量表的可行性和有效性。方法设计拟定基于健康促进理论的高中生预防艾滋病量表。采用整群随机抽样的方法,对上海市、福建省三明市和广西壮族自治区北海市的12 313名高一学生进行预防艾滋病量表测量,并对其中251名学生进行重复测量,考评其信度和效度。结果高中生预防艾滋病量表的内在信度Cronbach sα系数为0.608~0.916;重测信度考评中Sperman相关系数均>0.7;因子分析显示结构效度较好,15个公因子(包括知识、态度、信念和行为)能解释问卷全部内容的58.381%。结论该研究制定的高中生预防艾滋病量表具有良好的信度和效度,可用于相关研究。     

Acquired immunodeficiency syndrome associated disseminated Penicillium Marneffei infection: report of 8 cases

Penicillinosis Marneffei (PSM) is a rare fungal disease caused by systemic infection of Penicillium Marneffei (PM).     

Acquired immunodeficiency syndrome associated disseminated Penicillium Marneffei infection: report of 8 cases

Penicillinosis Marneffei(PSM)is a rare fungaldisease caused by systemic infection ofPenicilliumMarneffei(PM).Disseminated PSM is one of the mostcommon opportunistic infections in patients with acquiredimmunodeficiency syndrome(AIDS)living inSoutheastern region during the end-stage of disease.Sporadic and individual cases have been reported recentlyin China1-5and there appeared a tendency of increase ofPMinfections because of the increase of AIDS cases.Toimprove our understanding of th…     

正常人群、HIV感染者及获得性免疫缺陷综合征患者外周血CD28分子表达变化及临床意义

目的 探讨正常人群、HIV感染者及AIDS患者外周血CD28分子表达变化及临床意义.方法 选取AIDS患者、HIV感染患者及正常健康者各50例,分别设为A、B、C三组,比较三组间CD4+CD28+、CD8+CD28+T淋巴细胞计数和百分比,并分析血浆HIV病毒载量与CD4+、CD4+CD28+T淋巴细胞计数相关性.结果 A、B组CD4+T淋巴细胞计数和百分比水平显著低于C组,差异有统计学意义(P＜0.05);A组CD4+T淋巴细胞计数和百分比水平显著低于B组,差异有统计学意义(P＜0.05);B组CD8+T淋巴细胞计数水平显著高于A、C组,差异有统计学意义(P＜0.05);A、B组CD8+T淋巴细胞百分比水平显著高于C组,差异有统计学意义(P＜0.05);A组CD8+T淋巴细胞百分比水平显著高于B组,差异有统计学意义(P＜0.05);A、B组CD4+CD28+T淋巴细胞计数和百分比水平显著低于C组,差异有统计学意义(P＜0.05);A组CD4+CD28+T淋巴细胞计数和百分比水平显著低于B组,差异有统计学意义(P＜0.05);A组CD8+CD28+T淋巴细胞计数水平显著低于B、C组,差异有统计学意义(P＜0.05);A、B组CD8+CD28+T淋巴细胞百分比水平显著低于C组,差异有统计学意义(p＜0.05);A组CD8+CD28+T淋巴细胞百分比水平显著低于B组,差异有统计学意义(P＜0.05);A组血浆HIV病毒载量水平显著高于B组,差异有统计学意义(p＜0.05);CD4+和CD4+CD28+T淋巴细胞计数与血浆HIV病毒载量呈负相关(r=-0.781,-0.549,P=0.001,0.003).结论 HIV感染和AIDS患者随病情进展外周血T淋巴细胞CD28分子水平下降,可作为预后评价重要指标之一.     

猴免疫缺陷病毒感染猕猴快速进展型死亡特征

观察猴免疫缺陷病毒（ｓｉｍｉａｎｉｍｍｕｎｏｄｅｆｉｃｉｅｎｃｙｖｉｒｕｓ,ＳＩＶ）ＳＩＶｍａｃ和ＳＩＶｍａｃ２５１毒株感染猕猴快速进展型死亡的感染特征。方法用ＳＩＶｍａｃ和ＳＩＶｍａｃ２５１静脉接种,实验性感染８０只恒河猴和４只食蟹猴,定期采集静脉血浆进行病毒分离测定血浆病毒水平,间接免疫荧光法测定血浆病毒抗体水平,并取淋巴组织进行常规理组织学检查。结果８４只猕猴感染ＳＩＶｍａｃ和ＳＩＶｍａｃ２     

Premature atherosclerosis in patients with acquired immunodeficiency syndrome

Background Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus (HIV)infection since highly active antiretroviral therapy (HAART) has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients.Methods One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients (41HAART-treated and 41 antiretroviral therapy (ART) naive patients) and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity (PWV) was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage.Results A higher PWV ((1358.3±117.8) cm/s vs. (1270.2±189.2) cm/s, P=0.010) was found in ART na(i)ve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART na(i)ve patients ((1283.8±181.4) cm/s vs. (1358.0±117.8) cm/s, P=0.033). Multiple regression analysis revealed that age (B=5.218, 95% confidence interval (CI) 1.420-9.016, P=0.008), current smoking (B=-74.671, 95% CI -147.003 to -2.339, P=0.043) and HAART (92.7% patients on a protease inhibitor-free regimen) (B=-169.169, 95% CI-272.508 to -65.831, P=0.010) were associated with reduced PWV in HIV-infected patients.Conclusions Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.     

皖北地区获得性免疫缺陷综合征2例报道及启示

目的:探讨皖北地区获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)的临床病理学特点。方法:回顾性分析皖北地区2例AIDS的临床和病理学资料,并复习有关文献。结果:2例AIDS患者的人类免疫缺陷病毒(HIV)感染均经安徽省疾病控制中心(CDC)确认,1例主要表现为持续发热、消瘦、淋巴结病及带状疱疹,另1例主要表现为呼吸道症状。结论:在AIDS高发地区,临床和病理医师要熟悉AIDS的临床和病理学表现,对于不明原因的皮肤黏膜、淋巴结和呼吸道疾病,要考虑到AIDS的可能,并做进一步检查。     

探讨肾移植术后肺部巨细胞病毒感染的诊断与治疗

目的探讨肾移植术后肺部巨细胞病毒(CMV)感染的临床特点及治疗对策。方法回顾总结本院18例肾移植术后肺部CMV感染临床资料。结果18例肾移植术后肺部CMV感染病人经更昔洛韦为主的综合治疗治愈16例,死亡2例。结论对肾移植术后肺部CMV感染应该尽早诊断,及时应用以更昔洛韦为主的综合治疗。     

Premature atherosclerosis in patients with acquired immunodeficiency syndrome

Background Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus （HIV）infection since highly active antiretroviral therapy （HAART） has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients.Methods One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients （41HAART-treated and 41 antiretroviral therapy （ART） naive patients） and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity （PWV） was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage.Results A higher PWV （（1358.3±117.8） cm/s vs. （1270.2±189.2） cm/s, P=0.010） was found in ART na（i）ve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART na（i）ve patients （（1283.8±181.4） cm/s vs. （1358.0±117.8） cm/s, P=0.033）. Multiple regression analysis revealed that age （B=5.218, 95% confidence interval （CI） 1.420-9.016, P=0.008）, current smoking （B=-74.671, 95% CI -147.003 to -2.339, P=0.043） and HAART （92.7% patients on a protease inhibitor-free regimen） （B=-169.169, 95% CI-272.508 to -65.831, P=0.010） were associated with reduced PWV in HIV-infected patients.Conclusions Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.