艾滋病合并消化道溃疡的内镜下表现

Endoscopic manifestations of AIDS combined with digestive ulcer

摘要:

目的 探讨艾滋病（AIDS）合并不同类型消化道溃疡的内镜下特征。方法 收集2018年5月－2021年5月于该院消化科住院的20例AIDS合并消化道溃疡的患者的临床病例资料，总结归纳其内镜下表现和病理特征。结果 所有病例中发现：食管溃疡4例，胃溃疡3例，回盲部溃疡3例，回肠末端溃疡2例，结肠溃疡1例，直肠溃疡7例。病理提示：放线菌感染1例，结核杆菌感染2例，真菌感染1例，腺癌1例，鳞状细胞癌1例，非霍奇金淋巴瘤2例，慢性炎症12例。人类免疫缺陷病毒（HIV）核糖核酸（RNA）阳性者7例，HIV RNA值为1.40×10²～3.57×10⁵ IU/mL，平均（2.81±8.97）×10⁴ IU/mL。17例患者获得了CD4⁺的数据。其中，CD4⁺ < 250/μL者7例，CD4⁺ > 250/μL者10例。合并梅毒血清学阳性2例，血清巨细胞病毒（CMV）阳性1例。外周血HIV RNA阳性和CD4⁺ T细胞数量，与消化道恶性肿瘤（腺癌、鳞癌和非霍奇金淋巴瘤）（P = 0.268，P = 0.315）、特异性病原体感染（结核杆菌和放线菌）（P = 0.359，P = 0.621）以及普通炎性溃疡（P = 0.549，P = 0.058）无明显相关性。结论 HIV感染者的消化道溃疡病因与正常人群的溃疡病因明显不同，常由机会性感染或恶性肿瘤导致。如HIV感染患者因吞咽困难、胸骨后疼痛或腹痛至消化科门诊就诊，临床医师需警惕并发胃肠道疾病的可能，及时给予患者胃肠镜检查。

Abstract:

Objective To investigate the endoscopic features of acquired immunodeficiency syndrome (AIDS) combined with different types of digestive ulcers.Methods We collected the clinical data of 20 cases of AIDS complicated with digestive ulcer from May 2018 to May 2021, and made a summary of their endoscopic manifestations and pathology.Results There were 4 cases of esophageal ulcer, 3 cases of gastric ulcer, 3 cases of ileocecal ulcer, 2 cases of terminal ileum ulcer, 1 case of colon ulcer and 7 cases of rectal ulcer. Pathology revealed 1 case of actinomycete infection, 2 cases of tuberculosis infection, 1 case of fungal infection, 1 case of adenocarcinoma, 1 case of squamous cell carcinoma, 2 cases of non-Hodgkin lymphoma, and 12 cases of chronic inflammation. 7 cases were tested positive of human immunodeficiency virus (HIV) RNA, and the value ranged from 1.40×10² ～ 3.57×10⁵ IU/mL, with an average of (2.81 ± 8.97)×10⁴ IU/mL; 17 patients obtained CD4⁺ T lymphocytes data, among which 7 cases with CD4⁺ < 250/μL and 10 cases with CD4⁺ > 250/μL. There were 2 cases with syphilis serology positive and 1 case with serum cytomegalovirus (CMV) positive. We found that HIV RNA positive and CD4⁺ T cell counts in peripheral blood were not significantly associated with gastrointestinal malignancies (adenocarcinoma, squamous cell carcinoma and non-Hodgkin's lymphoma) (P = 0.268, P = 0.315), specific pathogen infections (Mycobacterium tuberculosis and Actinomycetes) (P = 0.359, P = 0.621) and common inflammatory ulcers (P = 0.549, P = 0.058).Conclusion The causes of these ulcers in HIV infected people may be significantly different from those in normal people, which is often caused by opportunistic infection or malignant tumor. HIV-infected patients often go to the gastroenterology clinic due to dysphagia, chest pain or abdominal pain. Clinicians need to be alert to the possibility of gastrointestinal diseases and perform endoscopy in time.