本文關(guān)鍵詞： 艾滋病 新型隱球菌性腦膜炎 中醫(yī)藥治療 抗病毒治療 藥物過(guò)敏　出處：《第三軍醫(yī)大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：云南是我國(guó)AIDS疫情最嚴(yán)重地區(qū)之一。近年來(lái)，流行趨勢(shì)呈現(xiàn)區(qū)域不斷擴(kuò)大，性傳播途徑明顯加快，發(fā)病和死亡分布高峰日益臨近，疫情流行態(tài)勢(shì)極為嚴(yán)峻，處于防治的關(guān)鍵時(shí)期。由于既往HIV感染者陸續(xù)進(jìn)入發(fā)病期，AIDS發(fā)病病例的增加以及死亡人數(shù)的增加使地區(qū)相關(guān)臨床工作面臨沉重負(fù)擔(dān)。作為AIDS防控領(lǐng)域的一線工作者，我們深感醫(yī)務(wù)人員迫切需要全面提高AIDS綜合治療水平，并開(kāi)展相關(guān)問(wèn)題的創(chuàng)新性試驗(yàn)研究。特別是關(guān)于機(jī)會(huì)性感染診治、抗病毒治療中毒副反應(yīng)及耐藥處理、中醫(yī)藥在艾滋病治療中的作用的研究。 本課題在常規(guī)工作的基礎(chǔ)上，對(duì)來(lái)源于云南省艾滋病關(guān)愛(ài)中心2004-2010年收治的確診AIDS病例開(kāi)展回顧性資料分析。著重開(kāi)展了以下工作：分析AIDS機(jī)會(huì)性感染病例特征；非核苷類反轉(zhuǎn)錄酶抑制劑的毒副作用觀察；中醫(yī)藥在艾滋病治療中初步療效觀察。相關(guān)研究結(jié)果如下： 1.2004-2010年云南省艾滋病關(guān)愛(ài)中心收治的40例AIDS合并腦膜炎（感染新型隱球菌）病例均進(jìn)入艾滋病期。其中男性22例，女性18例，年齡最小8歲，最大65歲，平均35.70±9.735歲。性傳播26例,靜脈吸毒9例，母嬰傳播1例，4例傳播途徑不明。40例患者均以發(fā)熱、頭痛為主要癥狀，其中23例患者合并其他機(jī)會(huì)性感染；所有病例治療前腦脊液壓力均超過(guò)300cmH2O。CD4細(xì)胞平均57.38±55.813/mm3。 2.40例AIDS合并腦膜炎患者全部采用靜脈滴注兩性霉素B及氟康唑，兩性霉素B從1mg開(kāi)始，逐漸加量，總量用至2.5-3g；氟康唑用量為400mg/天。同時(shí)進(jìn)行腦脊液引流治療。治愈24例，痊愈率85%。臨床癥狀消失時(shí)間為38.03±24.274天，病原陰轉(zhuǎn)時(shí)間為48.18±31.906天。死亡6例，病死率15%。 3.在1034接受抗病毒治療AIDS患者中，男性676例，女性358例，年齡39.30±10.12歲；靜脈吸毒310例，性傳播711例，傳播途徑不明13例，CD4細(xì)胞平均153.15±109.35/mm3。 4.在1034接受抗病毒治療AIDS患者中，486例采用一線抗病毒治療方案包括：依非韋倫，548例采用一線抗病毒方案包括：奈韋拉平。在全程治療中，依非韋倫和奈韋拉平的過(guò)敏率分別為9.26%和9.84%，無(wú)統(tǒng)計(jì)學(xué)差異（p0.05）,但依非韋倫引起過(guò)敏的時(shí)間為13.20±3.15天，，而奈韋拉平為18.83±6.68天，有顯著差異（p 0.01）。 5.在接受中西醫(yī)綜合治療的51例AIDS患者中，男性32例，女性19例，年齡26歲-72歲，平均36.8歲。吸毒感染19例，性傳播感染24例，不明原因感染8例，CD4細(xì)胞最低2/mm3,最高331/mm3,平均100.25±16.38/mm3。伴有多種臨床癥狀和機(jī)會(huì)性感染癥狀。 6.在標(biāo)準(zhǔn)西醫(yī)抗病毒治療的基礎(chǔ)上，按照國(guó)家標(biāo)準(zhǔn)，個(gè)性化辨證論治，實(shí)施基礎(chǔ)方主要藥物：太子參（人參），麥冬，五味子，黃芪，白術(shù)，茯苓，葛根，白芍等。51例患者經(jīng)綜合治療后顯效35例（68.6%），有效14例(27.5%)，無(wú)效2例(3.9%)，總有效率達(dá)到96.1%。
[Abstract]:Yunnan is one of the most serious areas of AIDS epidemic in China. In recent years, the epidemic trend is expanding, the route of sexual transmission is accelerating, and the peak of incidence and death is approaching. The epidemic situation is extremely severe, in the key period of prevention and treatment. Because of the past HIV infected persons have entered the onset stage one after another. The increasing incidence of AIDS and the increase in the number of deaths make the regional clinical work facing a heavy burden. As a front-line worker in the field of AIDS prevention and control. We feel that there is an urgent need for medical staff to comprehensively improve the level of comprehensive treatment for AIDS and to carry out innovative experimental studies on related issues, especially with regard to the diagnosis and treatment of opportunistic infections. Side effects and drug resistance in antiviral therapy, the role of traditional Chinese medicine in the treatment of AIDS. This subject is based on the routine work. A retrospective analysis of confirmed AIDS cases from 2004 to 2010 in Yunnan AIDS Care Center was carried out. The following work was focused on:. The characteristics of AIDS opportunistic infection were analyzed. The toxicity and side effects of non-nucleoside reverse transcriptase inhibitors were observed. The preliminary curative effect observation of Chinese medicine in AIDS treatment. Related research results are as follows: 1. From 2004 to 2010, 40 cases of AIDS complicated with meningitis (infected with Cryptococcus neoformans) were admitted to Yunnan AIDS Care Center. The average age of female was 35.70 鹵9.735 years old. There were 26 cases of sexual transmission, 9 cases of intravenous drug abuse and 1 case of mother-to-child transmission. Fever and headache were the main symptoms in 4 cases with unknown transmission route. 23 cases were complicated with other opportunistic infection. The cerebrospinal fluid pressure exceeded 300 cmH2O. CD4 cells averaged 57.38 鹵55.813% mm ~ (3) in all cases before treatment. 2.Amphotericin B and fluconazole were injected intravenously in all 40 patients with AIDS complicated with meningitis. Amphotericin B was added gradually from 1 mg to 2.5-3 g. The dosage of fluconazole was 400 mg / day. Cerebrospinal fluid drainage was performed simultaneously. 24 cases were cured and the recovery rate was 85. The time of clinical symptom disappearance was 38.03 鹵24.274 days. The time of negative transformation was 48.18 鹵31.906 days. 3. Of the 1034 AIDS patients receiving antiviral therapy, 676 were male and 358 were female, aged 39.30 鹵10.12 years. There were 310 cases of intravenous drug abuse, 711 cases of sexual transmission, and 13 cases of unknown transmission route. The average number of CD4 cells was 153.15 鹵109.35% / mm ~ (-3). 4. Of the 1034 patients receiving antiviral therapy for AIDS, 486 were treated with first-line antiviral therapy, including: Ephelon. The first line antiviral regimen included nevirapine. In the whole course of treatment, the allergy rates of efovirelen and nevirapine were 9.26% and 9.84, respectively. There was no significant difference (p0.05). However, the time of hypersensitivity was 13.20 鹵3.15 days and 18.83 鹵6.68 days, respectively. There was a significant difference between two groups (P < 0.01). 5. Among 51 patients with AIDS, 32 were males and 19 were females, aged from 26 to 72 years, with an average of 36.8 years. Twenty-four cases of sexually transmitted infections and 8 cases of unexplained infection were found to have the lowest CD4 cell count of 2 / mm ~ (-3), with a maximum of 331mm3. The average was 100.25 鹵16.38 r / mm 3, with multiple clinical symptoms and opportunistic infection symptoms. 6. on the basis of standard western antiviral therapy, according to the national standard, individualized treatment based on syndrome differentiation, the main drugs of basic prescription were implemented: Radix Pseudostellariae (Panax ginseng, Radix Ophiopogonis, Schisandra chinensis, Radix Astragali, Atractylodes macrocephala, Poria cocos, Pueraria. After comprehensive treatment, 35 cases (68.6%) were effective, 14 cases were effective, 2 cases had no effect, 2 cases had no effect, the total effective rate was up to 96.1%.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.91

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