云南省艾滋病关爱中心艾滋病病例临床特征综合分析

发布时间：2018-02-06 03:44

本文关键词： 艾滋病新型隐球菌性脑膜炎中医药治疗抗病毒治疗药物过敏　出处：《第三军医大学》2014年硕士论文　论文类型：学位论文

【摘要】：云南是我国AIDS疫情最严重地区之一。近年来，流行趋势呈现区域不断扩大，性传播途径明显加快，发病和死亡分布高峰日益临近，疫情流行态势极为严峻，处于防治的关键时期。由于既往HIV感染者陆续进入发病期，AIDS发病病例的增加以及死亡人数的增加使地区相关临床工作面临沉重负担。作为AIDS防控领域的一线工作者，我们深感医务人员迫切需要全面提高AIDS综合治疗水平，并开展相关问题的创新性试验研究。特别是关于机会性感染诊治、抗病毒治疗中毒副反应及耐药处理、中医药在艾滋病治疗中的作用的研究。本课题在常规工作的基础上，对来源于云南省艾滋病关爱中心2004-2010年收治的确诊AIDS病例开展回顾性资料分析。着重开展了以下工作：分析AIDS机会性感染病例特征；非核苷类反转录酶抑制剂的毒副作用观察；中医药在艾滋病治疗中初步疗效观察。相关研究结果如下： 1.2004-2010年云南省艾滋病关爱中心收治的40例AIDS合并脑膜炎（感染新型隐球菌）病例均进入艾滋病期。其中男性22例，女性18例，年龄最小8岁，最大65岁，平均35.70±9.735岁。性传播26例,静脉吸毒9例，母婴传播1例，4例传播途径不明。40例患者均以发热、头痛为主要症状，其中23例患者合并其他机会性感染；所有病例治疗前脑脊液压力均超过300cmH2O。CD4细胞平均57.38±55.813/mm3。 2.40例AIDS合并脑膜炎患者全部采用静脉滴注两性霉素B及氟康唑，两性霉素B从1mg开始，逐渐加量，总量用至2.5-3g；氟康唑用量为400mg/天。同时进行脑脊液引流治疗。治愈24例，痊愈率85%。临床症状消失时间为38.03±24.274天，病原阴转时间为48.18±31.906天。死亡6例，病死率15%。 3.在1034接受抗病毒治疗AIDS患者中，男性676例，女性358例，年龄39.30±10.12岁；静脉吸毒310例，性传播711例，传播途径不明13例，CD4细胞平均153.15±109.35/mm3。 4.在1034接受抗病毒治疗AIDS患者中，486例采用一线抗病毒治疗方案包括：依非韦伦，548例采用一线抗病毒方案包括：奈韦拉平。在全程治疗中，依非韦伦和奈韦拉平的过敏率分别为9.26%和9.84%，无统计学差异（p0.05）,但依非韦伦引起过敏的时间为13.20±3.15天，，而奈韦拉平为18.83±6.68天，有显著差异（p 0.01）。 5.在接受中西医综合治疗的51例AIDS患者中，男性32例，女性19例，年龄26岁-72岁，平均36.8岁。吸毒感染19例，性传播感染24例，不明原因感染8例，CD4细胞最低2/mm3,最高331/mm3,平均100.25±16.38/mm3。伴有多种临床症状和机会性感染症状。 6.在标准西医抗病毒治疗的基础上，按照国家标准，个性化辨证论治，实施基础方主要药物：太子参（人参），麦冬，五味子，黄芪，白术，茯苓，葛根，白芍等。51例患者经综合治疗后显效35例（68.6%），有效14例(27.5%)，无效2例(3.9%)，总有效率达到96.1%。
[Abstract]:Yunnan is one of the most serious areas of AIDS epidemic in China. In recent years, the epidemic trend is expanding, the route of sexual transmission is accelerating, and the peak of incidence and death is approaching. The epidemic situation is extremely severe, in the key period of prevention and treatment. Because of the past HIV infected persons have entered the onset stage one after another. The increasing incidence of AIDS and the increase in the number of deaths make the regional clinical work facing a heavy burden. As a front-line worker in the field of AIDS prevention and control. We feel that there is an urgent need for medical staff to comprehensively improve the level of comprehensive treatment for AIDS and to carry out innovative experimental studies on related issues, especially with regard to the diagnosis and treatment of opportunistic infections. Side effects and drug resistance in antiviral therapy, the role of traditional Chinese medicine in the treatment of AIDS. This subject is based on the routine work. A retrospective analysis of confirmed AIDS cases from 2004 to 2010 in Yunnan AIDS Care Center was carried out. The following work was focused on:. The characteristics of AIDS opportunistic infection were analyzed. The toxicity and side effects of non-nucleoside reverse transcriptase inhibitors were observed. The preliminary curative effect observation of Chinese medicine in AIDS treatment. Related research results are as follows: 1. From 2004 to 2010, 40 cases of AIDS complicated with meningitis (infected with Cryptococcus neoformans) were admitted to Yunnan AIDS Care Center. The average age of female was 35.70 卤9.735 years old. There were 26 cases of sexual transmission, 9 cases of intravenous drug abuse and 1 case of mother-to-child transmission. Fever and headache were the main symptoms in 4 cases with unknown transmission route. 23 cases were complicated with other opportunistic infection. The cerebrospinal fluid pressure exceeded 300 cmH2O. CD4 cells averaged 57.38 卤55.813% mm ~ (3) in all cases before treatment. 2.Amphotericin B and fluconazole were injected intravenously in all 40 patients with AIDS complicated with meningitis. Amphotericin B was added gradually from 1 mg to 2.5-3 g. The dosage of fluconazole was 400 mg / day. Cerebrospinal fluid drainage was performed simultaneously. 24 cases were cured and the recovery rate was 85. The time of clinical symptom disappearance was 38.03 卤24.274 days. The time of negative transformation was 48.18 卤31.906 days. 3. Of the 1034 AIDS patients receiving antiviral therapy, 676 were male and 358 were female, aged 39.30 卤10.12 years. There were 310 cases of intravenous drug abuse, 711 cases of sexual transmission, and 13 cases of unknown transmission route. The average number of CD4 cells was 153.15 卤109.35% / mm ~ (-3). 4. Of the 1034 patients receiving antiviral therapy for AIDS, 486 were treated with first-line antiviral therapy, including: Ephelon. The first line antiviral regimen included nevirapine. In the whole course of treatment, the allergy rates of efovirelen and nevirapine were 9.26% and 9.84, respectively. There was no significant difference (p0.05). However, the time of hypersensitivity was 13.20 卤3.15 days and 18.83 卤6.68 days, respectively. There was a significant difference between two groups (P < 0.01). 5. Among 51 patients with AIDS, 32 were males and 19 were females, aged from 26 to 72 years, with an average of 36.8 years. Twenty-four cases of sexually transmitted infections and 8 cases of unexplained infection were found to have the lowest CD4 cell count of 2 / mm ~ (-3), with a maximum of 331mm3. The average was 100.25 卤16.38 r / mm 3, with multiple clinical symptoms and opportunistic infection symptoms. 6. on the basis of standard western antiviral therapy, according to the national standard, individualized treatment based on syndrome differentiation, the main drugs of basic prescription were implemented: Radix Pseudostellariae (Panax ginseng, Radix Ophiopogonis, Schisandra chinensis, Radix Astragali, Atractylodes macrocephala, Poria cocos, Pueraria. After comprehensive treatment, 35 cases (68.6%) were effective, 14 cases were effective, 2 cases had no effect, 2 cases had no effect, the total effective rate was up to 96.1%.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.91

【参考文献】