Dworkin B, Wormser G P, Rosenthal W S, Heier S K, Braunstein M, Weiss L, Jankowski R, Levy D, Weiselberg S
Am J Gastroenterol. 1985 Oct;80(10):774-8.
Patients with acquired immunodeficiency syndrome (AIDS) frequently have diarrhea and weight loss. We prospectively examined the upper and lower gastrointestinal tracts in 22 AIDS patients, although severe medical problems often precluded full evaluation. Ninety-six percent (21 of 22) lost weight, and 55% (12 of 22) had diarrhea. The mean (+/- SD) weight loss was 34 +/- 19 lb. Steatorrhea was found in 4 of 14 patients, and D-xylose tests were abnormal in 8 of 14 patients. Mean serum albumin was 3.3 +/- 0.8 g/dl. A significantly diminished plasma selenium level, which can influence immune function, was noted in these AIDS patients. Gastrointestinal infections were identified in 45% of patients. Although diarrhea and malabsorption were more common in the infected group, weight loss and albumin were similar in those with and without demonstrated infections. Flexible sigmoidoscopy showed that of 15 patients, there were two with Kaposi's sarcoma, 10 normals, and three with nonspecific endoscopic changes of colitis. Infection was documented in all patients with colitis. Panendoscopy of the upper gastrointestinal tract was positive for AIDS-related pathology in five of 10 patients, including two with Kaposi's sarcoma, one with Candida esophagitis, one with herpetic esophagitis, and one with gastroduodenitis (biopsy positive for cryptosporidia); five patients had a normal-appearing tract. Small bowel or colonic biopsies frequently showed nonspecific inflammatory changes, although pathogens were identified in six patients (27% of all biopsies). We conclude that a wide variety of gastrointestinal pathology, which includes infectious agents, neoplasms, and inflammatory changes, may occur in AIDS patients. Therefore, AIDS patients, particularly those with diarrhea or weight loss, deserve an intensive evaluation for remediable lesions of their gastrointestinal tracts.
获得性免疫缺陷综合征（艾滋病）患者常出现腹泻和体重减轻。我们对22例艾滋病患者的上、下胃肠道进行了前瞻性检查，尽管严重的医疗问题常常妨碍全面评估。96%（22例中的21例）体重减轻，55%（22例中的12例）有腹泻。平均（±标准差）体重减轻34±19磅。14例患者中有4例出现脂肪泻，14例患者中有8例D-木糖试验异常。平均血清白蛋白为3.3±0.8g/dl。这些艾滋病患者的血浆硒水平显著降低，而硒水平会影响免疫功能。45%的患者发现有胃肠道感染。虽然腹泻和吸收不良在感染组更为常见，但有感染和无感染患者的体重减轻和白蛋白水平相似。乙状结肠镜检查显示，15例患者中，2例患有卡波西肉瘤，10例正常，3例有非特异性结肠炎内镜改变。所有结肠炎患者均有感染记录。10例患者中有5例上消化道内镜检查显示与艾滋病相关的病变，其中2例患有卡波西肉瘤，1例患有念珠菌食管炎，1例患有疱疹性食管炎，1例患有胃十二指肠炎症（活检隐孢子虫阳性）；5例患者的消化道外观正常。小肠或结肠活检常显示非特异性炎症改变，尽管6例患者（占所有活检的27%）发现了病原体。我们得出结论，艾滋病患者可能会出现多种胃肠道病变，包括感染性因子、肿瘤和炎症改变。因此，艾滋病患者，尤其是那些有腹泻或体重减轻的患者，值得对其胃肠道的可补救病变进行深入评估。
