Lim S G, Lipman M C, Squire S, Pillay D, Gillespie S, Sankey E A, Dhillon A P, Johnson M A, Lee C A, Pounder R E
University Department of Medicine, Royal Free Hospital and School of Medicine, London.
Gut. 1993 Oct;34(10):1429-32. doi: 10.1136/gut.34.10.1429.
An audit of upper gastrointestinal endoscopy in HIV infected patients with gastrointestinal symptoms assessed the frequency of disease detected by endoscopy and routine laboratory analysis of surveillance biopsy specimens. Sixty nine consecutive endoscopies were performed in 59 HIV infected patients. Endoscopic biopsy specimens were taken from the lower oesophagus, gastric antrum, and third part of the duodenum for virology, histopathology, parasitology, bacteriology, and mycobacterial culture. Endoscopic appearances detected disease in 25/59 (42.4%) patients (oesophageal candida, 14; oesophageal ulcer, 3; Kaposi's sarcoma, 4; others, 4), but only 4/43 (9.3%) specimens showed evidence of disease in the absence of endoscopic abnormality. Virology for cytomegalovirus (detection of early antigenic fluorescent foci and culture) was positive in 6/59 (10.2%) patients, but parasitology and mycobacterial culture were negative in all cases. Histopathology was abnormal in 11/52 (21%) oesophageal biopsy specimens, 13/47 (28%) gastric biopsy specimens, and 4/65 (6%) duodenal biopsy specimens. Abnormal findings were found predominantly in those with advanced HIV disease (CDC Stage IV) (21/33 patients (64%)) compared with those with early HIV disease (CDC Stage II) (5/26 (19%)). In conclusion, upper gastrointestinal endoscopy detects macroscopic disease in AIDS patients and those with low CD4 counts, but routine surveillance biopsy specimens of apparently normal bowel in early HIV disease (or where CD4 counts are greater than 0.2 x 10(9)/1) are of little value.
一项针对有胃肠道症状的HIV感染患者进行的上消化道内镜检查审计，评估了通过内镜检查及监测活检标本的常规实验室分析所检测到的疾病频率。对59例HIV感染患者连续进行了69次内镜检查。从食管下段、胃窦和十二指肠第三部分获取内镜活检标本，用于病毒学、组织病理学、寄生虫学、细菌学和分枝杆菌培养。内镜检查发现25/59（42.4%）的患者患有疾病（食管念珠菌病，14例；食管溃疡，3例；卡波西肉瘤，4例；其他，4例），但在4/43（9.3%）的标本中，在无内镜异常的情况下显示有疾病迹象。巨细胞病毒病毒学检测（早期抗原荧光灶检测和培养）在6/59（10.2%）的患者中呈阳性，但寄生虫学和分枝杆菌培养在所有病例中均为阴性。组织病理学显示，11/52（21%）的食管活检标本、13/47（28%）的胃活检标本和4/65（6%）的十二指肠活检标本异常。与早期HIV疾病（CDC II期）患者（5/26（19%））相比，异常发现主要见于晚期HIV疾病（CDC IV期）患者（21/33例患者（64%））。总之，上消化道内镜检查可检测出艾滋病患者及CD4细胞计数低的患者中的宏观疾病，但在早期HIV疾病（或CD4细胞计数大于0.2×10⁹/L）时，对看似正常肠道的常规监测活检标本价值不大。
