Carbó J, Laguna F, García-Samaniego J, Redondo C, Valencia E, Muñoz F, González-Lahoz J M
Servicio de Gastroenterología, Instituto de Salud Carlos III, Madrid.
Rev Esp Enferm Dig. 1995 Jul;87(7):499-504.
To describe all the clinical settings, endoscopic findings and response to therapy in a series of HIV-positive patients with biopsy proven gastrointestinal CMV disease.
We retrospectively reviewed the medical records of all HIV-infected patients who underwent digestive endoscopies at our Hospital from June 1990 to October 1993.
Twelve (7.5%) of 158 HIV-positive patients had gastrointestinal CMV disease. Sites of prove infection included the esophagus (n = 6, 50%), stomach (n = 2, 17%), duodenum (n = 4, 33.3%), ileum (n = 1, 8.5%) and colon (n = 2, 17%). The most common endoscopic findings were focal or diffuse mucosal ulcers. Three patients had pseudotumoral mucosal lesions. Cytomegalic cells were observed in 11 patients (91.6%) and immunohistochemical staining was positive in 9 (81.8%) of 11 patients tested. Eight patients completed a course of treatment with ganciclovir or foscarnet and all of them showed clinical improvement. The median survival time of our AIDS patients with CMV gastrointestinal disease was 7 weeks (range 1-39 weeks).
Gastrointestinal CMV disease may damage any site of the digestive tract in AIDS patients. Routine histopathologic examination was better than immunohistochemical staining for the diagnosis. Treatment improves the clinical situation in most of them. The mean survival is low and it is related to the degree of immunosuppression.
描述一系列经活检证实患有胃肠道巨细胞病毒（CMV）疾病的HIV阳性患者的所有临床情况、内镜检查结果及治疗反应。
我们回顾性分析了1990年6月至1993年10月在我院接受消化内镜检查的所有HIV感染患者的病历。
158例HIV阳性患者中有12例（7.5%）患有胃肠道CMV疾病。确诊感染部位包括食管（6例，50%）、胃（2例，17%）、十二指肠（4例，33.3%）、回肠（1例，8.5%）和结肠（2例，17%）。最常见的内镜检查结果是局灶性或弥漫性黏膜溃疡。3例患者有假瘤性黏膜病变。11例患者（91.6%）观察到巨细胞，11例接受检测的患者中有9例（81.8%）免疫组化染色呈阳性。8例患者完成了更昔洛韦或膦甲酸钠的一个疗程治疗，所有患者均显示临床症状改善。我们患有CMV胃肠道疾病的艾滋病患者的中位生存时间为7周（范围1 - 39周）。
胃肠道CMV疾病可能损害艾滋病患者消化道的任何部位。常规组织病理学检查在诊断方面优于免疫组化染色。治疗可改善大多数患者的临床状况。平均生存期较短，且与免疫抑制程度有关。
