摘要：
Objective To observe the histopathological features of different opportunistic infections and tumors of the intestinal mucosa in AIDS patients, and to explore the correlation between different lesions and CD4+ T lymphocyte levels. Methods Colonic mucosal biopsy specimens of 263 patients with clinically diagnosed AIDS and abdominal pain, diarrhea, blood in the stool and other gastrointestinal symptoms were collected from Beijing Ditan Hospital from 2010 to 2018. There were 232 males and 31 females, with age range 10-81 (mean 40 ± 13) years. HE staining, histochemical special staining, immunohistochemical staining, and in?situ hybridization were used to detect the expression of different opportunistic infection pathogens, tumors and CD4+ T lymphocytes. Peripheral blood was also taken for CD4+T lymphocytes, CD8+T lymphocytes, HIV viral load and routine indicators. Results The cohort included 263 intestinal mucosal biopsy specimens. There were 175 cases (66.5%) of non?specific inflammation, and pathogens were detected in 41 cases (15.6%), including 20 cases(7.6%) of cytomegalovirus (CMV) infection, 12 cases (4.6%) of mycobacterial infection, eight cases (3.0%) of amoeba infestation, and one case (0.3%) of talaromycesmarneffei infection; there were also 41 (15.6%) neoplastic lesions including 25 cases (9.5%) of intraepithelial neoplasia, 10 cases (3.8%) of adenocarcinoma and squamous cell carcinoma, six cases (2.3%) of lymphoma; and six cases (2.3%) of ulcerative colitis. The peripheral blood CD4+T lymphocyte levels of patients with CMV, mycobacteria and talaromycesmarneffei were less than 200/μL; the peripheral blood CD4+T lymphocyte level (P<0.01) and intestinal mucosa CD4+T lymphocytes (P<0.01) were all significantly lower than those in patients with non?specific inflammation. The peripheral red blood cells and hemoglobin levels of patients with CMV and mycobacterial infection (P<0.01), adenocarcinoma and squamous cell carcinoma (P<0.05) were significantly lower than those of non?specific inflammation patients. Conclusions Pathologic examination of intestinal mucosa can identify specific infections and neoplastic lesions in AIDS patients; the most common lesions are non?specific inflammation, and CMV infection is the most common opportunistic infections; CMV, mycobacteria and talaromycesmarneffei infections are associated with decreased levels of CD4+ T lymphocytes in peripheral blood and intestinal mucosa; entamoeba histolytica infestation and non?HIV?related neoplastic lesions such as intraepithelial neoplasia, adenocarcinoma and squamous cell carcinoma are not associated with changes in AIDS immune function.%目的 观察艾滋病患者肠黏膜不同机会性感染及肿瘤的病理组织学特点,并探讨不同病变与CD4+T淋巴细胞水平的相关性.方法 收集首都医科大学附属北京地坛医院2010至2018年临床诊断艾滋病并有腹痛、腹泻、便血等胃肠道症状的263例患者的结肠黏膜活检标本,患者中男性232例,女性31例,年龄10～81岁,平均年龄(40±13)岁.分别进行HE染色、组织化学特殊染色、免疫组织化学染色、原位杂交检测不同的机会性感染病原体、肿瘤及CD4+T淋巴细胞的表达;同时取外周血进行CD4+T淋巴细胞、CD8+T淋巴细胞、人免疫缺陷病毒(HIV)病毒载量、血常规相关指标检测.结果 263例肠黏膜活检标本均通过病理检查得到确诊,最多见的为非特异性炎性病变175例(66.5%),检测出病原体感染41例(15.6%),包括巨细胞病毒(CMV)感染20例(7.6%)、分枝杆菌感染12例(4.6%)、阿米巴原虫感染8例(3.0%)、马尔尼菲蓝状菌感染1例(0.3%);肿瘤性病变41例(15.6%),包括上皮内瘤变25例(9.5%)、腺癌及鳞状细胞癌10例(3.8%)、淋巴瘤6例(2.3%);另有6例(2.3%)溃疡性结肠炎样病变;其中CMV、分枝杆菌与马尔尼菲蓝状菌感染患者外周血CD4+T淋巴细胞水平均低于200个/μL,外周血CD4+T淋巴细胞水平(均P<0.01)及肠黏膜CD4+T淋巴细胞阳性标记指数(均P<0.01)均显著低于非特异性炎性病变患者;CMV与分枝杆菌感染患者(均P<0.01)、腺癌及鳞状细胞癌患者(均P<0.05)外周血红细胞、血红蛋白水平均显著低于非特异性炎性病变患者.结论 肠黏膜病理活检可明确特异性感染及肿瘤性病变;艾滋病患者肠黏膜最常见的病变是非特异性炎性病变,机会性感染病原体中以CMV感染最多见;肠黏膜CMV、分枝杆菌与马尔尼菲蓝状菌感染均与外周血及肠黏膜CD4+T淋巴细胞水平下降有关;阿米巴原虫感染、结肠上皮内瘤变、腺癌及鳞状细胞癌等非HIV相关肿瘤性病变与艾滋病免疫功能改变无关.
