Sánchez-Mejorada G, Ponce-de-León S
Infectious Diseases Department, National Institute of Nutrition, Mexico City, Mexico.
Rev Invest Clin. 1994 May-Jun;46(3):187-96.
To define the etiology and prognosis of diarrhea (acute, intermittent or chronic) in AIDS patients.
A retrospective analysis of patients with AIDS and diarrhea. Patterns of diarrhea were defined a priori. Endpoints of interest were etiology, rate of response to therapy, development of chronic diarrhea, and survival probability. Data were analyzed by means of univariate and multivariate tests (chi-square, ANOVA, Student's t test, Kaplan-Meier, logrank and logistic regression analysis).
A 170-bed tertiary-care university hospital which is one of the three most important referral centers for AIDS patients in Mexico City.
The records of the 279 AIDS patients admitted to the hospital between 1983 and 1989 were reviewed; 225 cases were suitable for analysis.
The presence of a diarrheal episode, the diagnostic studies to which the patient was submitted, the etiology, the response to therapy and the survival time from the point at which the diarrhea started were all recorded. Diarrheal patterns were stratified by clinical patterns and outcomes compared. Possible clinical predictors of chronic diarrhea were analyzed.
Seventy seven percent of the patients suffered at least one diarrheal episode. Diarrhea was in fact the most common AIDS-related complication in our series, and in 51% of the total cases (114/225), it was the first HIV-related symptom. The diarrheal pattern was intermittent in 47% of the cases, chronic in 36% and acute in the remaining 17%. An etiology was established in only 59% of the episodes, and Cryptosporidium was the etiologic agent most frequently isolated (30%). Other opportunistic pathogens prevailed in chronic and intermittent diarrheas. Chronic persistent diarrhea was related to a lower survival probability (60% at one year vs 90% for intermittent and 95% for acute diarrhea, p < 0.0001). When the performance of different diagnostic studies was analyzed, the combination of stool culture, serial parasitic examination and sigmoidoscopy with biopsies provided a high diagnostic accuracy (59%). Regardless of etiology, the rate of therapeutic success was directly related to the previous duration of diarrhea and the absolute lymphocyte count (p < 0.01).
There are three distinct diarrheal patterns common to AIDS patients. Although the etiologic agents do not vary significantly, each pattern has unique characteristics regarding the timing of presentation, their survival and therapeutic success rate. Such differences should be taken into account when therapeutic trials are designed.
明确艾滋病患者腹泻（急性、间歇性或慢性）的病因及预后。
对艾滋病合并腹泻患者进行回顾性分析。腹泻模式预先定义。关注的终点为病因、治疗反应率、慢性腹泻的发生情况及生存概率。数据通过单变量和多变量检验（卡方检验、方差分析、学生t检验、Kaplan-Meier法、对数秩检验和逻辑回归分析）进行分析。
一家拥有170张床位的三级护理大学医院，是墨西哥城最重要的三个艾滋病患者转诊中心之一。
回顾了1983年至1989年期间收治的279例艾滋病患者的记录；225例适合分析。
记录腹泻发作情况、患者接受的诊断检查、病因、治疗反应以及从腹泻开始时起的生存时间。根据临床模式对腹泻模式进行分层，并比较结果。分析慢性腹泻可能的临床预测因素。
77%的患者至少经历过一次腹泻发作。事实上，腹泻是我们研究系列中最常见的艾滋病相关并发症，在所有病例的51%（114/225）中，它是首个与HIV相关的症状。腹泻模式在47%的病例中为间歇性，36%为慢性，其余17%为急性。仅在59%的发作中确定了病因，隐孢子虫是最常分离出的病原体（30%）。其他机会性病原体在慢性和间歇性腹泻中占主导。慢性持续性腹泻与较低的生存概率相关（一年时为60%，间歇性腹泻为90%，急性腹泻为95%，p<0.0001）。分析不同诊断检查的效果时，粪便培养、系列寄生虫检查以及乙状结肠镜检查加活检的联合应用具有较高的诊断准确性（59%）。无论病因如何，治疗成功率与腹泻先前的持续时间和绝对淋巴细胞计数直接相关（p<0.01）。
艾滋病患者存在三种不同的腹泻模式。尽管病原体没有显著差异，但每种模式在出现时间、生存情况及治疗成功率方面具有独特特征。设计治疗试验时应考虑这些差异。
