Yuhan R, Orsay C, DelPino A, Pearl R, Pulvirenti J, Kay S, Abcarian H
Division of Colon and Rectal Surgery, Cook County Hospital and University of Illinois, Chicago 60612, USA.
Dis Colon Rectum. 1998 Nov;41(11):1367-70. doi: 10.1007/BF02237051.
Anorectal diseases are common in human immunodeficiency virus-infected individuals. The aim of this prospective study was to assess the cause and clinical presentation of anorectal disease in this human immunodeficiency virus-infected population.
A registry of all human immunodeficiency virus-seropositive patients with anorectal complaints who were referred to and followed up in the colorectal surgery clinic at a county hospital was maintained, with all data collected prospectively. All patients underwent examination under anesthesia with random cultures and biopsies, along with specific sampling of any suspicious lesions.
Data from 180 consecutive human immunodeficiency virus-seropositive patients with anorectal symptoms were analyzed. Mean age of the population was 34 years, with a male-to-female ratio of 14:1. This group comprised homosexual and bisexual males (55 percent), injection-drug users (15 percent), heterosexuals (12 percent), and others (18 percent). The average lag time from diagnosis of human immunodeficiency virus to anorectal symptoms was 48 months. The average CD4 lymphocyte count was 160 cells/mm3. The most common symptom was anorectal pain (57 percent), followed by lumps or warts (28 percent), rectal bleeding (12 percent), discharge (11 percent), and pruritus (6 percent), with 24 percent of patients having multiple complaints. Anal condyloma was the most prevalent pathology observed (43 percent), of which 10 percent was associated with anal intraepithelial neoplasia. Wide-based anal ulcers were the most frequent noncondylomatous lesions, occurring in 32 percent of patients, with the majority (91 percent) presenting with the chief complaint of anorectal pain. Some of these ulcers were associated with viral infections: herpes simplex virus (12 percent) and cytomegalovirus (7 percent). However, most ulcers were idiopathic, with negative cultures and biopsies. Other lesions encountered included fistulas (14 percent), abscesses (12 percent), hemorrhoids (6 percent), and malignancy, with two cases of Kaposi's sarcoma, one case of non-Hodgkin's lymphoma, and one case of squamous-cell carcinoma. More than one anorectal condition was identified in 16 percent of the patients.
Human immunodeficiency virus infection is associated with a wide spectrum of anorectal disease, of which the most common lesions are anal condylomata and painful ulcers. The majority of these anal ulcers gave negative culture and biopsy results. In addition, there seems to be a high incidence of anorectal neoplasia in this patient population.
肛门直肠疾病在感染人类免疫缺陷病毒的个体中很常见。这项前瞻性研究的目的是评估该感染人类免疫缺陷病毒人群中肛门直肠疾病的病因及临床表现。
建立了一个登记册，记录所有因肛门直肠不适前来某县医院结直肠外科门诊就诊并接受随访的人类免疫缺陷病毒血清学阳性患者，所有数据均为前瞻性收集。所有患者均在麻醉下接受检查，进行随机培养和活检，并对任何可疑病变进行特定取样。
分析了180例连续出现肛门直肠症状的人类免疫缺陷病毒血清学阳性患者的数据。该人群的平均年龄为34岁，男女比例为14:1。该组包括男同性恋和双性恋男性（55%）、注射吸毒者（15%）、异性恋者（12%）以及其他人群（18%）。从诊断人类免疫缺陷病毒到出现肛门直肠症状的平均间隔时间为48个月。平均CD4淋巴细胞计数为160个细胞/mm³。最常见的症状是肛门直肠疼痛（57%），其次是肿块或疣（28%）、直肠出血（12%）、分泌物（11%）和瘙痒（6%），24%的患者有多种症状。肛门尖锐湿疣是观察到的最常见病理情况（43%），其中10%与肛门上皮内瘤变有关。基底较宽的肛门溃疡是最常见的非湿疣性病变，发生在32%的患者中，大多数（91%）以肛门直肠疼痛为主诉。其中一些溃疡与病毒感染有关：单纯疱疹病毒（12%）和巨细胞病毒（7%）。然而，大多数溃疡是特发性的，培养和活检结果为阴性。其他遇到的病变包括肛瘘（14%）、脓肿（12%）、痔疮（6%）和恶性肿瘤，有2例卡波西肉瘤、1例非霍奇金淋巴瘤和1例鳞状细胞癌。16%的患者被发现有不止一种肛门直肠疾病。
人类免疫缺陷病毒感染与多种肛门直肠疾病有关，其中最常见的病变是肛门尖锐湿疣和疼痛性溃疡。这些肛门溃疡大多数培养和活检结果为阴性。此外，该患者人群中肛门直肠肿瘤的发病率似乎较高。
