6例HIV单一感染者非肝硬化性门静脉高压症的临床特征分析
DOI: 10.3969/j.issn.1001-5256.2022.09.028
Clinical characteristics of non-cirrhotic portal hypertension in HIV-monoinfected patients: An analysis of 6 cases
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关键词:
- 获得性免疫缺陷综合征 /
- 非肝硬化性门静脉高压 /
- 抗病毒药
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表 1 患者一般情况资料
Table 1. General data of patients
病例 年龄(岁) 性别 主要症状 既往史 HIV诊断时间 门静脉高压诊断时间 治疗时间及方案 1 46 男 间断黑便 否认 2015年 2016年 2015年开始使用拉米夫定、替诺福韦、依非韦伦抗病毒治疗 2 40 男 反复黑便 糖尿病1年 2013年 2016年 2013年开始使用拉米夫定、替诺福韦、依非韦伦抗病毒治疗 3 47 女 腹痛 否认 2004年 2018年 2004年—2014年抗病毒方案不详,2014年起换用克立芝、拉米夫定、替诺福韦抗病毒治疗 4 67 女 腹痛、呕血 否认 2015年 2020年 2015年开始使用拉米夫定、替诺福韦、依非韦伦抗病毒治疗,2020年更换为拉米夫定、替诺福韦、多替拉韦抗病毒治疗 5 43 男 腹痛、腹胀 因烧伤多次输血,胆囊炎行胆囊切除术 2019年 2021年 2019年开始使用拉米夫定、替诺福韦酯、依非韦伦抗病毒治疗 6 34 男 腹痛、呕血 高血压3年,糖尿病1年 2014年 2022年 2014年—2021年抗病毒方案不详,2021年调整为比克恩丙诺片(必妥维)抗病毒治疗 表 2 实验室检查结果
Table 2. Laboratory tests data of patients
检查指标 病例1 病例2 病例3 病例4 病例5 病例6 WBC(×109/L) 6.45 2.46 8.08 2.66 3.44 3.78 Hb(g/L) 64 44 151 104 138 57 PLT(×109/L) 49 106 424 76 87 101 ALT(U/L) 33 9 49 45 32 17 AST(U/L) 28 11 28 113 29 21 Alb(g/L) 34.4 34.5 41.1 33.7 40.9 33.0 TBil(μmol/L) 9.5 7.8 5.9 11.0 10.8 28.7 ALP(U/L) 132 78 186 229 122 63 GGT(U/L) 334 39 105 205 59 28 CD4(个/μg) 195.14 134 198 329 65 408 HIV RNA(拷贝/mL) TND TND TND <40 TND INR 1.27 1.01 1.17 1.09 1.21 1.27 PT(s) 14.2 11.3 13.2 12.2 13.5 14.3 TG(mmol/L) 0.55 1.95 1.93 0.73 1.19 1.15 CHOL(mmol/L) 4.21 3.33 3.54 4.08 3.24 2.93 HDL-C(mmol/L) 1.71 0.77 0.98 1.62 0.61 0.62 LDL-C(mmol/L) 2.1 1.68 1.62 1.74 1.87 1.56 Child分级 B级 A级 A级 B级 A级 A级 注:各指标的正常值范围如下,WBC(3.5×109/L~9.5×109/L),Hb(130~175)g/L,PLT(100×109/L~300×109/L),ALT(9~50)U/L,AST(15~40)U/L,Alb(40~55)g/L,TBil(5~21)μmol/L,ALP(45~125)U/L,GGT(10~60)U/L,CD4(544~1212)个/μg,INR(0.8~1.2),PT(9.9~12.8)s,TG<1.7 mmol/L,CHOL<5.18 mmol/L,HDL-C(1.0~1.6)mmol/L,LDL-C<2.6 mmol/L。TND,未检测到。 表 3 影像学及胃镜检查
Table 3. Imaging and gastroscopy
病例 FibroScan检查 胃镜 CT 病理 超声 1 24 kPa 食管静脉曲张(重度,红色征阳性);胃静脉曲张(GOV1型);门静脉高压性胃病 肝硬化;脾大;侧支循环形成;腹水;胆囊炎;胆囊结石 血管超声:门静脉栓子 2 胃底静脉曲张(重度);慢性非萎缩性胃炎 胃底静脉曲张;脾大;慢性胆囊炎;双肾囊肿 慢性纤维淤血性脾肿大。另送检小块肝组织示轻度肝脏病变 血管超声:双下肢深静脉未见血栓形成 3 9.5 kPa 食管静脉曲张(中度);胃静脉曲张可能,门静脉高压性胃病 肝硬化可能;脾大;胆囊息肉可能 慢性纤维淤血性脾肿大。肝内小叶间门静脉支闭塞,符合特发性门静脉高压症 腹部超声:弥漫性肝病表现(肝硬化不除外),脾大,门、脾静脉增宽,胆囊壁毛糙,未探及腹水 4 21.7 kPa 食管静脉曲张(重度,红色征阳性);胃静脉曲张(GOV1型);门静脉高压性胃病伴糜烂;十二指肠球霜斑样溃疡 肝硬化不除外;脾大;侧支循环形成;肝外胆管扩张,胰管略增宽;右肾上腺腺瘤可能;少量盆腹腔积液 5 食管静脉曲张(轻度,红色征阴性);门静脉高压性胃病;十二指肠霜斑样溃疡 胆总管多发结石伴肝内外胆管扩张;脾大 腹部超声:胆囊切除术后,肝管支架置入术后,肝内高回声结节-性质待定 6 53.3 kPa 食管静脉曲张(重度,红色征阳性);胃静脉曲张(GOV1型);门静脉高压性胃病 肝硬化可能;脾大;左肾实质钙化灶可能 -
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