Cacciarelli A G, Naddaf S Y, el-Zeftawy H A, Aziz M, Omar W S, Kumar M, Atay S, Abujudeh H, Gillooley J, Abdel-Dayem H M
Department of Medicine, St Vincent's Hospital and Medical Center of New York, Valhalla 10011, USA.
Clin Nucl Med. 1998 Apr;23(4):226-8. doi: 10.1097/00003072-199804000-00007.
AIDS patients are susceptible to opportunistic gastrointestinal infections including ascending cholangitis and cholecystitis, especially if CD4 count is < 200. Incidence of acalculous cholecystitis has not been reported previously.
We aim to evaluate the incidence of acalculous cholecystitis in AIDS patients and to identify causative organisms and mortality rate following cholecystectomy.
We reviewed the files of 46 patients in order to meet the objectives of this study.
CD4 counts were < 200 in 31 patients and > 200 in 15 patients. HIDA imaging was performed in 31 patients; in 8, the CD4 count was > 200 and all had calculous cholecystitis. The gallbladder was visualized in 3 patients for a sensitivity of 63% and no organisms were found in the gallbladder specimens. In 23 patients, the CD4 count was < 200; the gallbladder was visualized in 5 patients for a HIDA sensitivity of 78%; 16 (52%) had acalculous cholecystitis; and 15 had calculous cholecystitis. In acalculous cholecystitis, Cryptosporidium was found in six cases, cytomegalovirus (CMV) in six cases, and fungus, yeast, tuberculosis, and mycobacterium avium intracellular each in one case. The thirty day mortality rate was 18%; 5 of 28 who underwent open cholecystectomy died within 30 days, 4 of them with a CD4 count < 200. There was no mortality in the 26 patients who underwent laparoscopic cholecystectomy.
(1) Because of the high incidence of 52% of acalculous cholecystitis in AIDS patients with a CD4 count < 200, we recommend using intravenous cholecystokinin if the gallbladder is visualized on hepatobiliary scintigraphy in order to determine gallbladder ejection fraction and exclude acalculous cholecystitis. (2) Laparoscopic rather than open cholecystectomy should be the surgical procedure of choice in AIDS patients especially if the CD4 count is < 200.
艾滋病患者易发生机会性胃肠道感染，包括上行性胆管炎和胆囊炎，尤其是当CD4细胞计数<200时。此前尚未报道过无结石性胆囊炎的发病率。
我们旨在评估艾滋病患者无结石性胆囊炎的发病率，并确定致病微生物以及胆囊切除术后的死亡率。
为实现本研究的目的，我们查阅了46例患者的病历。
31例患者的CD4细胞计数<200，15例患者的CD4细胞计数>200。31例患者进行了肝胆动态显像；其中8例CD4细胞计数>200，均患有结石性胆囊炎。3例患者胆囊显影，灵敏度为63%，胆囊标本中未发现微生物。23例患者的CD4细胞计数<200；5例患者胆囊显影，肝胆动态显像灵敏度为78%；16例（52%）患有无结石性胆囊炎；15例患有结石性胆囊炎。在无结石性胆囊炎患者中，6例发现隐孢子虫，6例发现巨细胞病毒（CMV），1例分别发现真菌、酵母菌、结核和鸟分枝杆菌。30天死亡率为18%；28例行开腹胆囊切除术的患者中有5例在30天内死亡，其中4例CD4细胞计数<200。26例行腹腔镜胆囊切除术的患者无死亡病例。
（1）由于CD4细胞计数<200的艾滋病患者无结石性胆囊炎发病率高达52%，如果肝胆闪烁显像显示胆囊显影，我们建议使用静脉胆囊收缩素以确定胆囊排空分数并排除无结石性胆囊炎。（2）对于艾滋病患者，尤其是CD4细胞计数<200的患者，应选择腹腔镜而非开腹胆囊切除术作为手术方式。
