艾滋病慢性腹泻中医证候特点研究
|
摘要
目的
初步探索艾滋病慢性腹泻的临床特点,并依据导师的学术假说,进一步探索艾滋病慢性腹泻症状、证素、病机等中医证候方面规律及其实验室检查特点。
方法
采用回顾性病例调查与横断面研究相结合的方法。
1回顾性研究用预先制定的调查表对2006.1.1-2008.12.31期间在广州市第八人民医院感染科住院的符合艾滋病慢性腹泻诊断标准的病例进行调查,观测指标包括病例一般信息、症状、合并症、实验室检查、肠镜及病理共5个方面信息,并对数据进行整理分析。
2横断面调查用预先制定的调查表对2009.4.1-2009.10.31期间在广州市第八人民医院中医科和感染科住院部和门诊部就诊的病例进行调查。研究对象包括艾滋病无症状期(CD4>350 cells／ul.CD4≤350 cells／ul).发病期(腹泻、发热、咳嗽、疮疡)以及非艾滋病慢性腹泻共7组病例。观测指标包括一般信息、症状、证素、实验室检查共4个方面信息,并对数据进行整理分析。
3统计分析①定量资料：两个组别间对比时若数据呈正态分布则采用两独立样本率的T检验,呈非正态分布时采用两独立样本率的非参数检验(Mann—Whitney U)；多个组别间对比时采用单项方差分析(ANOVA):②定性资料：二分类变量数据采用2×2列联表两个独立样本率比较的卡方检验；多分类变量数据分析时若因变量为等级变量则采用多个独立样本率的非参数检验,若因变量为无序变量则采用R×C列联表分析。所有分析均以P<0.05为变量有显著性意义的标准。数据录入采用EpiDate 3.02软件,统计分析采用Spss13.0软件。
结果
1回顾性研究共66例病例纳入研究,其中进行大便培养者51例,肠镜检查者34例,病理组织学检查者28例。
1.1一般资料男性占53例(80.3%),所有病例平均年龄(39.227±10.171)岁,均为汉族,婚姻类别中未婚、已婚、丧偶、离异者分别占27.3%、68.2%、3.0%、1.5%,文化程度中小学、初中、高中／中专分别占13.6%、74.2%、12.1%,感染途径中有偿鲜血、输血、静脉吸毒、性接触、不明原因分别为1.5%、1.5%、39.4%、47.0%、10.6%；
1.2临床症状出现频次前5位的症状为：口腔豆腐渣样物48例(72.7%),畏寒47例(71.2%),乏力45例(68.2%),发热39例(59.1%)、纳差34例(51.5%),其余尚有咳嗽、气促、腹痛、恶心、呕吐等。
1.3合并症出现频次在10%以上的合并症为：口腔真菌感染48例(72.7%),肺部感染44例(66.7%),病毒性肝炎34例(51.5%),消瘦综合症28例(42.4%),结核21例(31.8%),深部真菌感染18例(27.3%),电解质紊乱16例(24.2%),疱疹病毒感染12例(18.2%),败血症9例(13.6%)；
1.4实验室检查WBC偏低者26例(39.4%),偏高者9例(13.6%)；RBC偏低者37例(56.1%)；有贫血表现者50例(75.8%)；PLT偏低者12例(18.2%),偏高者(21.2%)；LYM偏低者42例(63.6%),ALT偏高者18例(27.3%),AST偏高者41例(62.1%)；所有病例CD4在200以下,其中低于50者51例(77.3%)；大便培养中致病菌培养阳性10例(19.6%),其中真菌培养阳性7例(13.7%)。
1.5肠镜及病理检查各部分主要数据为：肠道固有层或黏膜充血水肿者31例(91.2%),病变解剖部位发生在乙状结肠和升结肠各20例(各占58.8%),结肠镜检查提示引起本病的肠道疾病有结肠炎18例(52.9%),肠镜检查提示为单一诊断者21例(61.8%)；病理组织学检查中肠道固有层或黏膜组织中淋巴细胞浸润22例(78.6%),粘膜充血水肿16例(57.1%),病变部位在乙状结肠13例(占46.4%),病理诊断为慢性非特异性结肠炎9例(32.1%)。
1.6学术假说①艾滋病病因病机复杂,涉及较多证素,且不同亚型病例病因病机存在一定差别；②艾滋病腹泻病因以疫毒侵袭为总因,复与湿邪等有关,病机以脾肾阳虚为主,多伴全身气虚,兼夹湿邪和／或淤血；③艾滋病腹泻病例在症状、实验室指标等方面与其他亚型病例存在一定差别。
2横断面调查共140病例纳入分析,平均分布于无症状期CD4>350组、无症状期CD4≤350组、艾滋病期腹泻组、发热组、咳嗽组、疮疡组以及非艾滋病腹泻对照组共七组,每组各20例病例。
2.1一般资料男性89例,男女比例为1.75：1,感染途径中血液途径11例(9.2%),性接触90例(75%),吸毒11例(9.2%),男性、汉族、已婚或同居、初中文化程度、工人和农民是本研究组病例的主要特点。
2.2症状特点无症状期组腹部不适、发热、神疲、身体困重、咳嗽、咳痰、咽喉不适、食少纳呆、口渴、口味异常、恶心呕吐、肢体倦怠、消瘦、面色少华、唇甲色淡、情绪低沉、出血17个症状频数低于发病期组,头痛、发脱2个症状高于发病期组。在腹泻组症状与其他各组的比较中,腹泻组腹部不适、发热、神疲、身体困重、食少纳呆、口渴、口味异常、肢体倦怠、消瘦、唇甲色淡、情绪低沉、畏寒肢冷12个症状频数高于CD4>350组,恶风寒、头痛2症状低于CD4>350组；腹泻组腹部不适、发热、神疲、身体困重、食少纳呆、口渴、口味异常、恶心呕吐、肢体倦怠、消瘦10个症状频数高于CD4≤350组,头痛频数低于CD4≤350组；腹泻组腹部不适、大便异常高于发热组,发热频数低于发热组；腹泻组腹部不适、耳鸣2症状频数高于疮疡组,皮肤瘙痒频数低于疮疡组；腹泻组腹部不适症状频数高于咳嗽组,咳嗽、咳痰2症状频数低于咳嗽组。腹泻组汗出异常、咳嗽、气短、口渴、肢体倦怠、消瘦、唇甲色淡、情绪低沉、耳鸣9个症状频数高于非艾滋病腹泻组。
2.3证素特点艾滋病腹泻组有脾、胃、湿、阳虚4证素高于无症状期CD4>350组；脾、湿2证素高于CD4≤350组,气虚证素低于CD4≤350组；脾、胃2证素高于发热组,胸隔证素低于发热组；脾、胃、阳虚3证素高于艾滋病咳嗽组,肝、肌肤、血虚3证素频数低于艾滋病咳嗽组；肾、胃、湿3证素高于疮疡组,肺证素低于疮疡组；肺、脾、肾、气虚、阳虚5证素高于非艾滋病腹泻组,小肠、大肠2个证素低于非艾滋病腹泻组,所有P<0.05。
2.4实验室检查特点发病期病例外周血Hb、RBC、LYM、CD4、CD8、CD4／CD8指标均低于无症状期组(P<0.01),艾滋病期病例Hb在腹泻组、发热组、咳嗽组均偏低(P<0.01),WBC在组间差异无显著意义,RBC在咳嗽组RBC含量偏低(P<0.01),PLT的各组间差异具有明显统计学意义(P<0.01),CD4、CD8和CD4／CD8在发病期4组均偏低,各组间差异具有明显统计学意义(P<0.01)；在腹泻组实验室指标与其他各组的多重比较中,Hb、PLT、CD8与各组间的差异无显著意义,RBC在CD4≤350组计数较高,CD4和CD4／CD8在CD4>350组计数较高。
结论
1艾滋病慢性腹泻病例证素和病因病机特点
1.1证素特点
病位证素主要在脾、肾、胃,病性证素以湿、气虚和阳虚为著。
1.2病因病机特点病因总因病毒入侵,复与房劳、精神、医过等有关；病机以脾肾阳虚为主,多伴气虚,并可兼夹湿邪阻滞和／或胃失和降。
1.3不同艾滋病亚型病例病因病机存在一定差别。
2艾滋病慢性腹泻病例症状特点
2.1常见症状
脘腹症状、水样便、烂便、身体困重、口腔豆腐渣样物、纳差(食少纳呆)、恶心呕吐、口味异常、口渴、畏寒肢冷、腰膝酸软、乏力(神疲、肢体倦怠)、唇甲色淡、面色少华、气促(气短)、情绪低落、畏寒、发热、汗出异常、咳嗽、咽喉不适、健忘等。
2.2艾滋病腹泻组病例临床表现比无症状期和非艾滋病腹泻病例更为严重。
2.3不同艾滋病亚型病例临床症状存在一定差别。
3艾滋病慢性腹泻病例实验室检查特点
3.1艾滋病腹泻病例实验室指标特点
多有RBC、Hb下降和AST升高及CD4明显下降；肠镜和病理检查多见肠道形态学改变以黏膜充血水肿为主,肠黏膜组织大量淋巴细胞浸润,病变部位以回盲瓣、乙状结肠、升结肠、回肠、横结肠较多。
3.2不同艾滋病亚型病例实验室指标存在一定差别。
4艾滋病慢性腹泻病例一般特征
具备下列特征的人群有较高的患病率和发病率：男性、中年、汉族、已婚、初中文化程度、性接触和静脉吸毒及血液传播、职业为无业或商业人员或农民或工人。
5艾滋病慢性腹泻病因病机研究方法
回顾性研究和横断面研究相结合是一种较好的研究方法,可以避免结论真实性的偏倚和研究资源的浪费。
Objectives:
To explore the clinical characters of Acquired Immunodeficiency syndrome (AIDS)-Associated chronic Diarrhea (AACD) and make further study of it's regularities on symptoms, symptom factors, mechanism of disease etc. in TCM theory and laboratory findings based on the hypothesis of advisor.
Methods:
The integration of retrospective study and cross-sectional study was adopted.
1 Retrospective study:With pre-formed questionnaire, medical data from patients with ARCBD and hospitalized at the Infection Department of The 8th Hospital of Guangzhou City from Jan 1,2006 to Dec 31,2008, contains demographics, symptoms, complications, laboratory findings, enteroscopy and histopathologic examination were retrospective analyzed.
2 Cross-sectional study:With pre-formed questionnaire, medical data from patients received intervention at either In-department or Out-department of Infection Department and TCM Department to The 8th Hospital of Guangzhou City from Apr 1,2009 to Oct 31,2009, contains demographics, symptoms, symptom factors, and laboratory findings were analyzed. The eligable participants includes 3 groups divided into 7 subgroups, which contain CD4>350 cells/ul (High Concentration in the Asymptomatic Stage, HCAS), CD4≤350 cells/ul (Low Concentration in the Asymptomatic Stage, LCAS) in the stage I, CAAD, AIDS-Associated Fever (AAF), AIDS-Associated Cough (AAC), AIDS-Associated Maculopapular Rash (AAMR) in the stageⅡ-Ⅳ, and No AIDS-Associated Diarrhea (NAAD).
3 Statistical Analysis:Using the Two-Independent-Samples T Test for data with normal distribution and Two-Independent-Samples Nonparametric Test (Mann-Whitney U) for data with nonnormal distribution between two groups, ANOVA for the comparison among different groups, chi-square statistics by 2X2 contingency tables for dichotomous variables, and RXC contingency tables for the disordered dependent variables. Variable with statistically results at a p-level<0.05 were considered as significantly. With EpiDate 3.02 and Spss13.0 software, the data entry and analysis were performed respectively.
Results
1 Retrospective study:A total of 66 patients were enrolled in the outcome analysis. Of these,51,34,28 patients with feces culture, enteroscopy and histopathologic examination, respectively.
1.1 Subject Characteristics Of those 66 patients (Ages:39.227±10.171, Male: 80.3%), singlehood, married, loss of spouse, and dissociation were 27.3%, 68.2%,3.0%and 1.5%respectively, elementary school, primary school and high school education were 13.6%,74.2%and 12.1%, sell blood, blood transfusion, drug abuse through intravenous injection, sex and in nubibus reasons were 1.5%, 1.5%,39.4%,47.0%and 10.6%respectively in the routes of infection.
1.2 Symptoms:According to the frequency, the former 5 symptoms were tofukasu analog in oral cavity (72.7%), chilly (71.2%), debilitation (68.2%), fever (59.1%), and anorexy (51.5%), which may accompany with cough, gasping, bellyache, nausea, vomiting etc..
1.3 Complications:Complications with the frequency percentage≥10%contained oral thrush (72.7%), pneumonia infection (66.7%), virus hepatitis (51.5%), cachexia (42.4%), tuberculosis (31.8%), fungal infections (27.3%), electrolyte disturbances (24.2%), cytomegalovirus (18.2%), and septicemia (13.6%).
1.4 Laboratory findings:26 (39.4%),37 (56.1%),50 (75.8%),12 (18.2%),42 (63.6%),0 (0), and 0(0) patients had lower WBC, RBC, HGB, PLT, LYM, AST, and ALT concentration than normal range respectively, contrarily,9 (13.6%),0 (0),0(0),14 (21.2%),0(0),18 (27.3%), and 41 (62.1%) patients had higher concentration respectively. CD4≤200 cells/ul for all patients, of these, 51 (77.3%) patients were≤50 cells/ul. And 10 (19.6%) patients had positive results in the feces culture, of these,7 (13.7%) were positively in the eumycete culture.
1.5 enteroscopy and histopathologic examination:31 patients (91.2%) had hyperemia and edema in the lamina propria or mucosa of intestinal tract, which had occurred in the sigmoid colon and ascending colon (58.8%), and 18 patients (52.9%) were diagnosed as colonitis. In the histopathologic examination,22 patients (78.6%) had lymphocyte infiltration in the lamina propria or mucosa of intestinal tract, and 9 patients (32. 1%)were diagnosed as non-specificity colonitis.
1.6 Hypothesis:(1) Because many symptom factors were involved, the reasons and mechanism of AIDS were complicated, and were variably among different subtypes of AIDS; (2) The reasons of CAAD was the invasion of Ai poison, and the mechanism of CAAD was the spleen-kidney yang deficiency mainly, which maybe accompany with qi deficiency, dampness obstruction and/or congestion; (3) Patients with CAAD has own characters on symptoms and laboratory findings, which maybe different with other subtypes of AIDS.
2 cross-sectional study:A total of 140 patients were enrolled in the outcome analysis. Of these,20 patients were divided in HCAS, LCAS, CAAD, AAF, AAC, AAMR and NAAD subgroup in average, respectively.
2.1 Subject Characteristics:Of these 140 patients (Male:63.6%), male, HAN people, married or cohabitation, primary school education, farmer or laborer were the main characters. In addition, blood transfusion, sex and drug abuse through intravenous injection were 9.2%,75%, and 9.2%respectively in the routes of infection.
2.2 Symptoms:17 symptoms which include abdominal discomfort, fever, tired, weary and heavy body, cough, expectoration, throat indisposition, anorexy, thirsty, abnormal taste, nausea and vomiting, lassitude, emaciation, light on face, light color on lip and nail, depression and bleeding in the asymptomatic stage had higher present percentage than patients in the stageⅡ-Ⅳ, but the headache and alopecie were lower. In the comparison between CAAD and other subtypes,12 symptoms which include abdominal discomfort, fever, tired, weary and heavy body, anorexy, thirsty, abnormal taste, debilitation, emaciation, light color on lip and nail, depression, chill and limb cold had higher present percentage than patients in the HCAS subgroup, but the aversion to wind and cold and headache were lower;
10 symptoms which include abdominal discomfort, fever, tired, weary and heavy body, anorexy, thirsty, abnormal taste, nausea and vomiting, debilitation and emaciation had higher present percentage than patients in the LCAS subgroup, but the headache were lower; abdominal discomfort and abnormal stool had higher present percentage than patients in the AAF subgroup, but the fever was lower; abdominal discomfort and tinnitus had higher present percentage than patients in the AAMR subgroup, but the itch of skin was lower; abdominal discomfort was higher than patients in the AAC subgroup, but cough and expectoration was lower; 9 symptoms which include abnormal perspiration, cough, gasping, thirsty, tired, emaciation, light color on lip and nail, depression and tinnitus had higher present percentage than patients in the NAAD subgroup.
2.3 symptom factors:In the comparison between CAAD and other subtypes,4 symptom factors include spleen, stomach, dampness and yang deficiency had higher present frequency than HCAS; spleen and dampness were higher than LCAS; spleen and stomach were higher but the septum pectorale was lower than AAF; spleen, stomach and yang deficiency had higher present frequency but the liver, skin and blood deficiency were lower than AAC; kidney, stomach and dampness were higher but the pneumonia was lower than AAMR; 5 symptom factors include pneumonia, spleen, kidney, qi deficiency and yang deficiency had higher present frequency but the small intestine and large intestine were lower than NAAD, and all the values of P<0.05.
2.4 Laboratory findings:Concentration of HGB, RBC, LYM, CD4, CD8 and CD4/CD8 in the stageⅡ-Ⅳwere higher than patients in the asymptomatic stage. In the comparison between CAAD and other subtypes, HGB, RBC, PLT, CD4, CD8 and CD4/CD8 had significant difference in the analysis between subgroups, and in the multiple comparisons, RBC concentration in the LCAS was higher, and CD4 concentration and CD4/CD8 in the HCAS were higher than CAAD, but the HGB, PLT and CD8 concentration were nonsignificance.
Conclusion
1 The characters of symptom factors and mechanism of AACD
1.1 The characters of symptom factors:The location of disease were main focused on spleen, kidney and stomach, and the nature of disease main focused on dampness, qi deficiency and yang deficiency mainly.
1.2 The characters of reasons and mechanism The reasons of disease was the invasion of Ai poison, which effected by sex, mental health and iatrogenic lapsus etc.. The mechanism of disease was spleen-kidney yang deficiency mainly, which maybe accompany with qi deficiency, dampness obstruction and/or stomach disharmony.
1.3 The characters of reasons and mechanism were variably among different subtypes of AIDS.
2 The symptoms characters of AACD
2.1 Normal clinical symptoms:abdominal discomfort, watery stool, rotten stool, weary and heavy body, tofukasu analog in oral cavity, anorexy, nausea and vomiting, abnormal taste, thirsty, chill and limb cold, feeble on waist and knee, debilitation, light color on lip and nail, light on face, gasping, depression, chill, fever, abnormal perspiration, cough, throat indisposition, forgetful etc..
2.2 The clinical symptoms of patients with CAAD were more severe than patients in the asymptomatic stage or with NAAD.
2.3 The characters of symptoms were variably among different subtypes of AIDS.
3 The characters of laboratory findings of AACD
3.1 The characters of laboratory findings:Usually accompany with descent of RBC, HGB and CD4 especially, and heighten of AST. In the enteroscopy and histopathologic examination, morphology change of intestinal tract were the hyperemia and edema mainly, and usually had lymphocyte infiltration, which often occurred in the ileal valve, sigmoid colon, ascending colon, ileum and transverse colon.
3.2 The characters of laboratory findings were variably among different subtypes of AIDS.
4 The common demographics characters of AACD
People with the following demographics characters may have high risks on the morbidity of AIDS or CAAD:male, middle aged, HAN people, married, primary school education, sex or drug abuse through intravenous injection or blood transfusion, and the occupation was farmer, or laborer, or commerce personnel, or unemployment.
5 Approaches of reasons and mechanism of AACD study
The integration of retrospective study and cross-sectional study was a suitable method for the reasons and mechanism of CAAD study, which may avoid the biases of the validity and the waste of research resources.
初步探索艾滋病慢性腹泻的临床特点,并依据导师的学术假说,进一步探索艾滋病慢性腹泻症状、证素、病机等中医证候方面规律及其实验室检查特点。
方法
采用回顾性病例调查与横断面研究相结合的方法。
1回顾性研究用预先制定的调查表对2006.1.1-2008.12.31期间在广州市第八人民医院感染科住院的符合艾滋病慢性腹泻诊断标准的病例进行调查,观测指标包括病例一般信息、症状、合并症、实验室检查、肠镜及病理共5个方面信息,并对数据进行整理分析。
2横断面调查用预先制定的调查表对2009.4.1-2009.10.31期间在广州市第八人民医院中医科和感染科住院部和门诊部就诊的病例进行调查。研究对象包括艾滋病无症状期(CD4>350 cells／ul.CD4≤350 cells／ul).发病期(腹泻、发热、咳嗽、疮疡)以及非艾滋病慢性腹泻共7组病例。观测指标包括一般信息、症状、证素、实验室检查共4个方面信息,并对数据进行整理分析。
3统计分析①定量资料：两个组别间对比时若数据呈正态分布则采用两独立样本率的T检验,呈非正态分布时采用两独立样本率的非参数检验(Mann—Whitney U)；多个组别间对比时采用单项方差分析(ANOVA):②定性资料：二分类变量数据采用2×2列联表两个独立样本率比较的卡方检验；多分类变量数据分析时若因变量为等级变量则采用多个独立样本率的非参数检验,若因变量为无序变量则采用R×C列联表分析。所有分析均以P<0.05为变量有显著性意义的标准。数据录入采用EpiDate 3.02软件,统计分析采用Spss13.0软件。
结果
1回顾性研究共66例病例纳入研究,其中进行大便培养者51例,肠镜检查者34例,病理组织学检查者28例。
1.1一般资料男性占53例(80.3%),所有病例平均年龄(39.227±10.171)岁,均为汉族,婚姻类别中未婚、已婚、丧偶、离异者分别占27.3%、68.2%、3.0%、1.5%,文化程度中小学、初中、高中／中专分别占13.6%、74.2%、12.1%,感染途径中有偿鲜血、输血、静脉吸毒、性接触、不明原因分别为1.5%、1.5%、39.4%、47.0%、10.6%；
1.2临床症状出现频次前5位的症状为：口腔豆腐渣样物48例(72.7%),畏寒47例(71.2%),乏力45例(68.2%),发热39例(59.1%)、纳差34例(51.5%),其余尚有咳嗽、气促、腹痛、恶心、呕吐等。
1.3合并症出现频次在10%以上的合并症为：口腔真菌感染48例(72.7%),肺部感染44例(66.7%),病毒性肝炎34例(51.5%),消瘦综合症28例(42.4%),结核21例(31.8%),深部真菌感染18例(27.3%),电解质紊乱16例(24.2%),疱疹病毒感染12例(18.2%),败血症9例(13.6%)；
1.4实验室检查WBC偏低者26例(39.4%),偏高者9例(13.6%)；RBC偏低者37例(56.1%)；有贫血表现者50例(75.8%)；PLT偏低者12例(18.2%),偏高者(21.2%)；LYM偏低者42例(63.6%),ALT偏高者18例(27.3%),AST偏高者41例(62.1%)；所有病例CD4在200以下,其中低于50者51例(77.3%)；大便培养中致病菌培养阳性10例(19.6%),其中真菌培养阳性7例(13.7%)。
1.5肠镜及病理检查各部分主要数据为：肠道固有层或黏膜充血水肿者31例(91.2%),病变解剖部位发生在乙状结肠和升结肠各20例(各占58.8%),结肠镜检查提示引起本病的肠道疾病有结肠炎18例(52.9%),肠镜检查提示为单一诊断者21例(61.8%)；病理组织学检查中肠道固有层或黏膜组织中淋巴细胞浸润22例(78.6%),粘膜充血水肿16例(57.1%),病变部位在乙状结肠13例(占46.4%),病理诊断为慢性非特异性结肠炎9例(32.1%)。
1.6学术假说①艾滋病病因病机复杂,涉及较多证素,且不同亚型病例病因病机存在一定差别；②艾滋病腹泻病因以疫毒侵袭为总因,复与湿邪等有关,病机以脾肾阳虚为主,多伴全身气虚,兼夹湿邪和／或淤血；③艾滋病腹泻病例在症状、实验室指标等方面与其他亚型病例存在一定差别。
2横断面调查共140病例纳入分析,平均分布于无症状期CD4>350组、无症状期CD4≤350组、艾滋病期腹泻组、发热组、咳嗽组、疮疡组以及非艾滋病腹泻对照组共七组,每组各20例病例。
2.1一般资料男性89例,男女比例为1.75：1,感染途径中血液途径11例(9.2%),性接触90例(75%),吸毒11例(9.2%),男性、汉族、已婚或同居、初中文化程度、工人和农民是本研究组病例的主要特点。
2.2症状特点无症状期组腹部不适、发热、神疲、身体困重、咳嗽、咳痰、咽喉不适、食少纳呆、口渴、口味异常、恶心呕吐、肢体倦怠、消瘦、面色少华、唇甲色淡、情绪低沉、出血17个症状频数低于发病期组,头痛、发脱2个症状高于发病期组。在腹泻组症状与其他各组的比较中,腹泻组腹部不适、发热、神疲、身体困重、食少纳呆、口渴、口味异常、肢体倦怠、消瘦、唇甲色淡、情绪低沉、畏寒肢冷12个症状频数高于CD4>350组,恶风寒、头痛2症状低于CD4>350组；腹泻组腹部不适、发热、神疲、身体困重、食少纳呆、口渴、口味异常、恶心呕吐、肢体倦怠、消瘦10个症状频数高于CD4≤350组,头痛频数低于CD4≤350组；腹泻组腹部不适、大便异常高于发热组,发热频数低于发热组；腹泻组腹部不适、耳鸣2症状频数高于疮疡组,皮肤瘙痒频数低于疮疡组；腹泻组腹部不适症状频数高于咳嗽组,咳嗽、咳痰2症状频数低于咳嗽组。腹泻组汗出异常、咳嗽、气短、口渴、肢体倦怠、消瘦、唇甲色淡、情绪低沉、耳鸣9个症状频数高于非艾滋病腹泻组。
2.3证素特点艾滋病腹泻组有脾、胃、湿、阳虚4证素高于无症状期CD4>350组；脾、湿2证素高于CD4≤350组,气虚证素低于CD4≤350组；脾、胃2证素高于发热组,胸隔证素低于发热组；脾、胃、阳虚3证素高于艾滋病咳嗽组,肝、肌肤、血虚3证素频数低于艾滋病咳嗽组；肾、胃、湿3证素高于疮疡组,肺证素低于疮疡组；肺、脾、肾、气虚、阳虚5证素高于非艾滋病腹泻组,小肠、大肠2个证素低于非艾滋病腹泻组,所有P<0.05。
2.4实验室检查特点发病期病例外周血Hb、RBC、LYM、CD4、CD8、CD4／CD8指标均低于无症状期组(P<0.01),艾滋病期病例Hb在腹泻组、发热组、咳嗽组均偏低(P<0.01),WBC在组间差异无显著意义,RBC在咳嗽组RBC含量偏低(P<0.01),PLT的各组间差异具有明显统计学意义(P<0.01),CD4、CD8和CD4／CD8在发病期4组均偏低,各组间差异具有明显统计学意义(P<0.01)；在腹泻组实验室指标与其他各组的多重比较中,Hb、PLT、CD8与各组间的差异无显著意义,RBC在CD4≤350组计数较高,CD4和CD4／CD8在CD4>350组计数较高。
结论
1艾滋病慢性腹泻病例证素和病因病机特点
1.1证素特点
病位证素主要在脾、肾、胃,病性证素以湿、气虚和阳虚为著。
1.2病因病机特点病因总因病毒入侵,复与房劳、精神、医过等有关；病机以脾肾阳虚为主,多伴气虚,并可兼夹湿邪阻滞和／或胃失和降。
1.3不同艾滋病亚型病例病因病机存在一定差别。
2艾滋病慢性腹泻病例症状特点
2.1常见症状
脘腹症状、水样便、烂便、身体困重、口腔豆腐渣样物、纳差(食少纳呆)、恶心呕吐、口味异常、口渴、畏寒肢冷、腰膝酸软、乏力(神疲、肢体倦怠)、唇甲色淡、面色少华、气促(气短)、情绪低落、畏寒、发热、汗出异常、咳嗽、咽喉不适、健忘等。
2.2艾滋病腹泻组病例临床表现比无症状期和非艾滋病腹泻病例更为严重。
2.3不同艾滋病亚型病例临床症状存在一定差别。
3艾滋病慢性腹泻病例实验室检查特点
3.1艾滋病腹泻病例实验室指标特点
多有RBC、Hb下降和AST升高及CD4明显下降；肠镜和病理检查多见肠道形态学改变以黏膜充血水肿为主,肠黏膜组织大量淋巴细胞浸润,病变部位以回盲瓣、乙状结肠、升结肠、回肠、横结肠较多。
3.2不同艾滋病亚型病例实验室指标存在一定差别。
4艾滋病慢性腹泻病例一般特征
具备下列特征的人群有较高的患病率和发病率：男性、中年、汉族、已婚、初中文化程度、性接触和静脉吸毒及血液传播、职业为无业或商业人员或农民或工人。
5艾滋病慢性腹泻病因病机研究方法
回顾性研究和横断面研究相结合是一种较好的研究方法,可以避免结论真实性的偏倚和研究资源的浪费。
Objectives:
To explore the clinical characters of Acquired Immunodeficiency syndrome (AIDS)-Associated chronic Diarrhea (AACD) and make further study of it's regularities on symptoms, symptom factors, mechanism of disease etc. in TCM theory and laboratory findings based on the hypothesis of advisor.
Methods:
The integration of retrospective study and cross-sectional study was adopted.
1 Retrospective study:With pre-formed questionnaire, medical data from patients with ARCBD and hospitalized at the Infection Department of The 8th Hospital of Guangzhou City from Jan 1,2006 to Dec 31,2008, contains demographics, symptoms, complications, laboratory findings, enteroscopy and histopathologic examination were retrospective analyzed.
2 Cross-sectional study:With pre-formed questionnaire, medical data from patients received intervention at either In-department or Out-department of Infection Department and TCM Department to The 8th Hospital of Guangzhou City from Apr 1,2009 to Oct 31,2009, contains demographics, symptoms, symptom factors, and laboratory findings were analyzed. The eligable participants includes 3 groups divided into 7 subgroups, which contain CD4>350 cells/ul (High Concentration in the Asymptomatic Stage, HCAS), CD4≤350 cells/ul (Low Concentration in the Asymptomatic Stage, LCAS) in the stage I, CAAD, AIDS-Associated Fever (AAF), AIDS-Associated Cough (AAC), AIDS-Associated Maculopapular Rash (AAMR) in the stageⅡ-Ⅳ, and No AIDS-Associated Diarrhea (NAAD).
3 Statistical Analysis:Using the Two-Independent-Samples T Test for data with normal distribution and Two-Independent-Samples Nonparametric Test (Mann-Whitney U) for data with nonnormal distribution between two groups, ANOVA for the comparison among different groups, chi-square statistics by 2X2 contingency tables for dichotomous variables, and RXC contingency tables for the disordered dependent variables. Variable with statistically results at a p-level<0.05 were considered as significantly. With EpiDate 3.02 and Spss13.0 software, the data entry and analysis were performed respectively.
Results
1 Retrospective study:A total of 66 patients were enrolled in the outcome analysis. Of these,51,34,28 patients with feces culture, enteroscopy and histopathologic examination, respectively.
1.1 Subject Characteristics Of those 66 patients (Ages:39.227±10.171, Male: 80.3%), singlehood, married, loss of spouse, and dissociation were 27.3%, 68.2%,3.0%and 1.5%respectively, elementary school, primary school and high school education were 13.6%,74.2%and 12.1%, sell blood, blood transfusion, drug abuse through intravenous injection, sex and in nubibus reasons were 1.5%, 1.5%,39.4%,47.0%and 10.6%respectively in the routes of infection.
1.2 Symptoms:According to the frequency, the former 5 symptoms were tofukasu analog in oral cavity (72.7%), chilly (71.2%), debilitation (68.2%), fever (59.1%), and anorexy (51.5%), which may accompany with cough, gasping, bellyache, nausea, vomiting etc..
1.3 Complications:Complications with the frequency percentage≥10%contained oral thrush (72.7%), pneumonia infection (66.7%), virus hepatitis (51.5%), cachexia (42.4%), tuberculosis (31.8%), fungal infections (27.3%), electrolyte disturbances (24.2%), cytomegalovirus (18.2%), and septicemia (13.6%).
1.4 Laboratory findings:26 (39.4%),37 (56.1%),50 (75.8%),12 (18.2%),42 (63.6%),0 (0), and 0(0) patients had lower WBC, RBC, HGB, PLT, LYM, AST, and ALT concentration than normal range respectively, contrarily,9 (13.6%),0 (0),0(0),14 (21.2%),0(0),18 (27.3%), and 41 (62.1%) patients had higher concentration respectively. CD4≤200 cells/ul for all patients, of these, 51 (77.3%) patients were≤50 cells/ul. And 10 (19.6%) patients had positive results in the feces culture, of these,7 (13.7%) were positively in the eumycete culture.
1.5 enteroscopy and histopathologic examination:31 patients (91.2%) had hyperemia and edema in the lamina propria or mucosa of intestinal tract, which had occurred in the sigmoid colon and ascending colon (58.8%), and 18 patients (52.9%) were diagnosed as colonitis. In the histopathologic examination,22 patients (78.6%) had lymphocyte infiltration in the lamina propria or mucosa of intestinal tract, and 9 patients (32. 1%)were diagnosed as non-specificity colonitis.
1.6 Hypothesis:(1) Because many symptom factors were involved, the reasons and mechanism of AIDS were complicated, and were variably among different subtypes of AIDS; (2) The reasons of CAAD was the invasion of Ai poison, and the mechanism of CAAD was the spleen-kidney yang deficiency mainly, which maybe accompany with qi deficiency, dampness obstruction and/or congestion; (3) Patients with CAAD has own characters on symptoms and laboratory findings, which maybe different with other subtypes of AIDS.
2 cross-sectional study:A total of 140 patients were enrolled in the outcome analysis. Of these,20 patients were divided in HCAS, LCAS, CAAD, AAF, AAC, AAMR and NAAD subgroup in average, respectively.
2.1 Subject Characteristics:Of these 140 patients (Male:63.6%), male, HAN people, married or cohabitation, primary school education, farmer or laborer were the main characters. In addition, blood transfusion, sex and drug abuse through intravenous injection were 9.2%,75%, and 9.2%respectively in the routes of infection.
2.2 Symptoms:17 symptoms which include abdominal discomfort, fever, tired, weary and heavy body, cough, expectoration, throat indisposition, anorexy, thirsty, abnormal taste, nausea and vomiting, lassitude, emaciation, light on face, light color on lip and nail, depression and bleeding in the asymptomatic stage had higher present percentage than patients in the stageⅡ-Ⅳ, but the headache and alopecie were lower. In the comparison between CAAD and other subtypes,12 symptoms which include abdominal discomfort, fever, tired, weary and heavy body, anorexy, thirsty, abnormal taste, debilitation, emaciation, light color on lip and nail, depression, chill and limb cold had higher present percentage than patients in the HCAS subgroup, but the aversion to wind and cold and headache were lower;
10 symptoms which include abdominal discomfort, fever, tired, weary and heavy body, anorexy, thirsty, abnormal taste, nausea and vomiting, debilitation and emaciation had higher present percentage than patients in the LCAS subgroup, but the headache were lower; abdominal discomfort and abnormal stool had higher present percentage than patients in the AAF subgroup, but the fever was lower; abdominal discomfort and tinnitus had higher present percentage than patients in the AAMR subgroup, but the itch of skin was lower; abdominal discomfort was higher than patients in the AAC subgroup, but cough and expectoration was lower; 9 symptoms which include abnormal perspiration, cough, gasping, thirsty, tired, emaciation, light color on lip and nail, depression and tinnitus had higher present percentage than patients in the NAAD subgroup.
2.3 symptom factors:In the comparison between CAAD and other subtypes,4 symptom factors include spleen, stomach, dampness and yang deficiency had higher present frequency than HCAS; spleen and dampness were higher than LCAS; spleen and stomach were higher but the septum pectorale was lower than AAF; spleen, stomach and yang deficiency had higher present frequency but the liver, skin and blood deficiency were lower than AAC; kidney, stomach and dampness were higher but the pneumonia was lower than AAMR; 5 symptom factors include pneumonia, spleen, kidney, qi deficiency and yang deficiency had higher present frequency but the small intestine and large intestine were lower than NAAD, and all the values of P<0.05.
2.4 Laboratory findings:Concentration of HGB, RBC, LYM, CD4, CD8 and CD4/CD8 in the stageⅡ-Ⅳwere higher than patients in the asymptomatic stage. In the comparison between CAAD and other subtypes, HGB, RBC, PLT, CD4, CD8 and CD4/CD8 had significant difference in the analysis between subgroups, and in the multiple comparisons, RBC concentration in the LCAS was higher, and CD4 concentration and CD4/CD8 in the HCAS were higher than CAAD, but the HGB, PLT and CD8 concentration were nonsignificance.
Conclusion
1 The characters of symptom factors and mechanism of AACD
1.1 The characters of symptom factors:The location of disease were main focused on spleen, kidney and stomach, and the nature of disease main focused on dampness, qi deficiency and yang deficiency mainly.
1.2 The characters of reasons and mechanism The reasons of disease was the invasion of Ai poison, which effected by sex, mental health and iatrogenic lapsus etc.. The mechanism of disease was spleen-kidney yang deficiency mainly, which maybe accompany with qi deficiency, dampness obstruction and/or stomach disharmony.
1.3 The characters of reasons and mechanism were variably among different subtypes of AIDS.
2 The symptoms characters of AACD
2.1 Normal clinical symptoms:abdominal discomfort, watery stool, rotten stool, weary and heavy body, tofukasu analog in oral cavity, anorexy, nausea and vomiting, abnormal taste, thirsty, chill and limb cold, feeble on waist and knee, debilitation, light color on lip and nail, light on face, gasping, depression, chill, fever, abnormal perspiration, cough, throat indisposition, forgetful etc..
2.2 The clinical symptoms of patients with CAAD were more severe than patients in the asymptomatic stage or with NAAD.
2.3 The characters of symptoms were variably among different subtypes of AIDS.
3 The characters of laboratory findings of AACD
3.1 The characters of laboratory findings:Usually accompany with descent of RBC, HGB and CD4 especially, and heighten of AST. In the enteroscopy and histopathologic examination, morphology change of intestinal tract were the hyperemia and edema mainly, and usually had lymphocyte infiltration, which often occurred in the ileal valve, sigmoid colon, ascending colon, ileum and transverse colon.
3.2 The characters of laboratory findings were variably among different subtypes of AIDS.
4 The common demographics characters of AACD
People with the following demographics characters may have high risks on the morbidity of AIDS or CAAD:male, middle aged, HAN people, married, primary school education, sex or drug abuse through intravenous injection or blood transfusion, and the occupation was farmer, or laborer, or commerce personnel, or unemployment.
5 Approaches of reasons and mechanism of AACD study
The integration of retrospective study and cross-sectional study was a suitable method for the reasons and mechanism of CAAD study, which may avoid the biases of the validity and the waste of research resources.
引文
[1]聂青和.感染性腹泻病,北京：人民卫生出版社,2000,第1版：583-589.
[2]NACO report on AIDS in India 2004 [http://www. naco. gov. in].
[3]World Health Organization:Acquired immunodeficiency syndrome (AIDS): interim proposal for a WHO staging system for HIV infection and disease. Wkly Epidem Rec,1990;65:221-4.
[4]Lew EA, Poles MA, Dieterich DT. Diarrheal disease associated with HIV infection. Gastroenterol Clin North Am,1997;26:259-290.
[5]全海燕.38例艾滋病的临床分析.当代医学,2006;(11)：85-86.
[6]陈筱纯,吕晓菊,叶慧,等.HIV/AIDS感染者109例临床分析.中国感染与化疗杂志,2008：8(3)：183-186.
[7]张复春,唐小平.广州地区108例艾滋病临床流行病学特征分析.热带医学杂志,2002：2(4)：429-431.
[8]李梦东.艾滋病相关性腹泻.世界华人消化杂志,2001;9(8)：937-938.
[9]法科学家发现艾滋病病毒新亚型.生物学教学,2010;35(1)：78.
[10]王维真,刘康迈,危剑安,等.艾滋病临床治疗与护理培训教材.北京：北京大学医学出版社,2003,第1版：12-16.
[11]Ameisen JC. Capron A. Cell dysfunction and depletion in AIDS:The programmed cell deathhypothesis. Immunol Today,1991;12:102-105.
[12]池莉,水波,张永容.艾滋病发病机制中的细胞凋亡理论.中国实验动物学杂志,2000：10(4)：245-249.
[13]刘水青,徐斌,吴吴.HIV感染的免疫发病机制和免疫重建.国外医学·流行病学传染病学分册,2003,30(12)：323-325.
[14]Silvestri G, Feinberg MB. Turnover of lymphoeytes and conceptual paradigms in HIV infection. J Clin Invest,2003;112:821-824.
[15]曾耀英.HIV感染发病学的新概念.河南中医学院学报,2005;20(119)：1-5.
[16]李太生,王爱霞,邱志峰.艾滋病的免疫发病机制和免疫重建.中华医学杂志,2001：81(5)：310-312.
[17]Eggena MP, Barugahare B, Jones N, et al. Depletion of regulatory T cells intheHIVinfectionisassociatedwithimmuneactivation. Immunol,2005; 174: 4407-4414.
[18]汪习成,吴吴.HIV-1的潜伏储藏库.国外医学(流行病学传染病学分册),2001：28：6-10.
[19]Pope M, Haase AT. Transmission acute HIV-1 infection and the quest for strategies to prevent infection. Nat Med,2003;9:847-852.
[20]焦艳梅,吴昊.HIV-1潜伏库研究进展.首都医学大学学报,2009;30(5)：639-641.
[21]加、美科学家发现艾滋病病毒在人体内藏身之地-记忆T细胞,有助于研发治愈艾滋病的新方法.生物学教学,2010;35(1)：78-79.
[22]Stoiber H, Kacani L, Speth C, et al. The supportive role of complement in HIV pathogenesis. Immunol Rev,2001;180:168-176.
[23]张淑玲,罗端德.艾滋病的发病机制和病理改变.新医学,2006;37(1)：11-13.
[24]李海英,吴昊.HIV致病机制研究进展从中医理论谈艾滋病的发病机制.中国病原生物学杂志,2008：3(3)：227-229.
[25]赵树珍.艾滋病中医证治探讨.浙江中医杂志.1989；24(10)：435.
[26]孙利民,危剑安,黄霞珍,等.从中医理论谈艾滋病的发病机制.中华中医药杂志,2005;20(2)：100-101.
[27]王小平,刘颖,张永祥,等.艾乃吉Ⅰ号抗艾滋病的实验研究.山东中医杂志,2006：25(7)：474-476.
[28]蒋心悦.浅析爱滋病的病因病机.中国医药学报,2001;16(6)：41-42.
[29]郭选贤,谢世平,孙林,等.艾滋病中医病因病机研究概况.中医研究,2007：20(5)：59-61.
[30]张苑莉.中医治疗艾滋病的理论基础和方法的探讨.天津中医,1994;11(2)：46.
[31]黄炳山.中医治疗艾滋病.哈尔滨：黑龙江科学技术出版社,1990：25.
[32]胡建华,李秀惠,刘翠娥,等.100例艾滋病病例中医辨证分型研究.北京中医,2007：26(2)：97-98.
[33]赵晓梅,吕维柏.中医药治疗艾滋病的临床探析.中医杂志,1996;37(8)：499.
[34]陈听,田春,陈玉珍.223例HIV/AIDS病例不同分期中医舌象分析与病机探讨.中国中医药信息杂志,2008;15(12)：20-22.
[35]陈秀敏.艾滋病发热的火罐应用及辨证施护.光明中医,2009;24(8)：1580-1581.
[36]罗玲,李太生.AIDS抗病毒治疗的历史、现状与未来.传染病信息,2009：22(6)：321-324.
[37]张颖,白雪帆,孙永涛.抗人类免疫缺陷病毒-1基因治疗的新进展.中华传染病杂志,2005;23(1)：61-63.
[38]中成药唐草片获得批准用于改善艾滋病症状.中国中医药信息杂志,2004：11(5)：466.
[39]危剑安,金燕,陈宇霞,等.艾灵颗粒治疗18例HIV/AIDS病例12个月临床总结.传染病信息,2006;19(5)：256-258.
[40]田圣志,张怀亮,施钧瀚,等.爱可扶正片治疗HIV/AIDS112例3年临床疗效总结.世界中西医结合杂志,2009;4(1)：23-25.
[41]黄卫平,王健,于智敏,等.艾通治疗艾滋病病毒感染及艾滋病病例15例.中国中医药信息杂志,2002：9(11)：49-50.
[42]王健,于智敏,李国勤,等.中研2号治疗艾滋病病毒感染及艾滋病病例29例临床观察.2001：42(7)：418-420.
[43]马伯艳,符林春,陈谐捷,等.艾可清胶囊治疗获得性免疫缺陷综合征疗效分析.中医杂志,2007：48(12)：1092-1094.
[44]张苗苗,符林春,蔡卫平,等.艾可清胶囊对HIV感染者的疗效观察.中华中医药学刊,2008：26(10)：2233-2236.
[45]曹廷智,刘水滕,王辉,等.艾可清联合HAART治疗艾滋病30例临床观察.中国医药前沿,2008：3(20)：1-4.
[46]张骁,雍晓春,张韬.艾滋病疫苗研发最新进展.中国制药信息,2010;26(1)：6-16.
[47]http:／／www.chinadaily.com.cn／hqgj／2009—09／25／content_8734652.htm. 2009／9／25.
[48]http:／／www.cavax.org／newsview.asp?id=355.2010／3／26.
[49]龙渊,杨小洁,赵淑雯.辨证分型治疗腹泻55例疗效观察.云南中医中药杂志,2006：27(4)：6-7.
[50]丁远富.慢性腹泻的中西医结合诊治.中华实用中西医杂志,2006;19(16)：1975.
[51]李海强,贝光明,周翼,等.249例慢性腹泻病例血液流变学及结肠镜检查分析.中医研究,2009：22(3)：36-38.
[52]郁晓维,王丽慧,王明明.迁延性腹泻中医证型探讨.时珍国医国药,2007;18(4)：968-969.
[53]陆海英,霍娜,童一帆,等.S ARS伴腹泻病例的临床特点.世界华人消化杂志,2003：11(12)：1929-1931.
[54]韩晓群,韩晓青,徐德翠.肝源性腹泻29例分析.中西医结合肝病杂志,2007：17(3)：178-179.
[55]沈培源,吴德平.肝源性腹泻的中医辨治.长春中医学院学报,2002;18(1)：1 8.
[56]翟亭立,薛庆光.肠易激综合征及其中医证型与胃肠激素的相关性研究.基层医学论坛,2010：14：85-86.
[57]王丽华,董宏生,李颖辰,等.肠易激综合征中医证型血中胃肠激素水平初探.中医药学刊,2005;23(9)：1618-1619.
[58]舒士敏,顾洁.辨证治疗腹泻型肠易激综合征50例.河北中医,2009：31(7)：989.
[59]许成群.糖尿病性腹泻的中医病机浅析.陕西中医学院学报,2004;27(3)：7-8.
[60]王文成,郭勇.中医药治疗化疗相关性腹泻的研究述略.实用中医内科杂志,2008：22(10)：79-81.
[61]马纯清.四君子汤合四神丸加减治疗慢性腹泻临床观察.光明中医,2009：24(11)：2119-2120.
[62]姜敏.中医辨证治疗糖尿病性腹泻43例.河北中医,2007;29(11)：1037.
[63]张志明.加味实脾饮治疗抗生素相关性腹泻90例临床观察.卫生职业教育,2009：27(15)：138-139.
[64]高培阳,王春霞.中医药治疗抗生素相关性腹泻30例分析.实用中西医结合临床,2007：7(5)：20-21.
[65]陈建新.温补脾肾法治疗慢性腹泻 36例. 实用中医内科杂志,2008：22(6)：36.
[66]李虹.健脾益肾法治疗慢性腹泻43例.陕西中医,2005,26(9)：921.
[67]祁江宁.祛寒除湿法治疗非感染性腹泻体会.光明中医,2007;22(12);23-25.
[68]Sanchez TH, Brooks JT, Sullivan PS, et al. Bacterial diarrhea in persons with HIV infection, United States,1992-2002. Clin Infect Dis,2005; 41(11):1621-1627.
[69]Rebecca A, Dillingham, Relana Pinkerton, et al. Pinkerton High Early Mortality in Patients with Chronic Acquired Immunodeficiency Syndrome Diarrhea Initiating Antiretroviral Therapy in Haiti:A Case-Control Study. Am. J. Trop. Med. Hyg.,2009; 80 (6):1060-1064.
[70]Assi M, McKinsey DS, Driks MR, et al. Gastrointestinal histoplasmosis in the acquired immunodeficiency syndrome:report of 18 cases and literature review. Diagn Microbiol Infect Dis,2006;55(3):195-201.
[71]彭继承,罗宜辉,李运泽.以腹泻为主要临床表现的艾滋病37例分析.中国实用医药,2009：4(31)：66-67.
[72]Garro S, Bava AJ. Cryptococcus neoformans in the gastric contents of an AIDS patient. Rev Argent Microbiol,2006;38(4):206-208.
[73]Ukarapol N, Chartapisak W, Lertprasertsuk N, et al. Cytomegalovirus-a ssociated manifestations involving the digestive tract in children with human immunodeficiency virus infe ction. J Pediatr Gastroenterol Nutr,2002; 35 (5):669-673..
[74]GuarinoA, Bruzzese E, De Marco G, et al. Management of gastrointestinal disorders in children with HIV infection. Paediatr Drugs, 2004; 6 (6):347-362.
[75]Dillingham RA, Lima AA, Guerrant RL. Cryptosporidiosis:epidemiology and impact. Microbes Infect.2002;4(10):1059-1066.
[76]Kuppamuthu Ramakrishnan, Rajaiah shenbagarathai, Alagappan Uma, et al. Prevalence of intestinal parasitic infestation in HIV/AIDS patience with Diarrhea in Madurai City, Sourth, India. Jpn. J. Infect. Dis.2007;60:209-210.
[77]Ramakrishnan K, Shenbagarathai R, Uma A, et al. Prevalence of intestinal parasitic infestation in HIV/AI DS patients with diarrhea in Madurai City, South India. Jpn J Infect Dis,2007;60(4):209-210.
[78]Dwivedi KK, Prasad G, Saini S, et al. Enteric opportunistic parasites among HIV infected individuals associated risk factors and immune status. Jpn J Infect Dis,2007;60(2-3):76-81.
[79]Rossit AR, de Almeida MT, Nogueira CA, et Al. Bacterial, yeast, parasitic, and viral enteropathogens in HIV-infected children from Sao Paulo State, Soutlleastern Brazil. Diagn Microbiol Infect Dis,2007; 57(1):59-66.
[80]Rebecca A, Dillingham, Relana Pinkerton, et al. High Early Mortality in Patients with Chronic Acquired Immunodeficiency Syndrome Diarrhea Initiating Antiretroviral Therapy in Haiti:A Case-Control Study. Am. J. Trop. Med. Hyg,2009; 80 (6):1060-1064.
[81]Brink AK, Mahe C, Watera C, et al. Diarrhea, CD4 counts and enteric infections in a community-based cohort of HIV-infected adults in Uganda. J Infect.2002;45(2):99-106.
[82]李坪,毛羽,兰孟东,等.HIV(+)非特异性慢性结肠炎腹泻病例结肠黏膜血管的改变.世界华人消化杂志.2008：16(14)：1530-1534.
[83]韦浪曲.艾滋病病例11例肠镜特征分析.临床内科杂志,2008;25(5)：304.
[84]周锦,张晶,徐樨巍.表现为慢性腹泻的儿童艾滋病7例.实用儿科临床杂志,2008：23(10)：763-764.
[85]杨克利,龙翠英.AIDS并慢性腹泻的血液学变化与死亡的关系.中国误诊学杂志,2005：5(15)：2818-2819.
[86]Suresh VS Attili.AK Gulati, VP Singh. Et al. Diarrhea, CD4 counts and enteric infections in a hospital-based cohort of HIV-infected patients around Varanasi, India. BMC Infectious Diseases.2006;6:39.
[87]Derouin, Francisl; Lagrange-Xelot, et al. Treatment of parasitic diarrhea in HIV-infected patients.2008;6(3):337-349.
[88]Frederic Clayton, Donald P. Kotler, Scott K. Kuwada, et al. A Possible Cause of Human Immunodeficiency Virus Enteropathy. American Journal of Pathology,2001;159(5):1933-9.
[89]Dayanithi G, Yahi N, Baghdiguian S, et al. Intracellular calcium release induced by human immunodeficiency virus type 1 (HIV-1) surface envelope glycoprotein in human intestinal pithelial cells:a putative mechanism for HIV-1 enteropathy. Cell Calcium 1995; 18:9-18.
[90]Delezay 0, Yahi N, Tamalet C, et al. Direct effect of type 1 human immunodeficiency virus (HIV-1) on intestinal epithelial cell differenti-ation:relationship to HIV-1 enteropathy. Virology 1997; 238:231-242.
[91]Stockmann M, Schmitz H, Fromm M, et al. Mechanisms of epithelial barrier impairment in HIV infection. Ann N Y Acad Sci.2000;915:293-303.
[92]Schmitz H, Rokos K, Florian P, et al. Supernatants of HIV-infected immune cells affect the barrier function of human HT-29/B6 intestinal epithelial cells. AIDS.2002; 16(7):983-91.
[93]Mehandru S, Poles MA, Tenner-Racz K, et al. Primary HIV-1 infection is associated with preferential depletion of CD4 T lymphocytes from effector sites in the gastrointestinal tract. J Exp Med 2004; 200:761-770.
[94]Brenchley JM, Schacker TW, Ruff LE, et al. CD4 T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract. J Exp Med 2004;200:749-759.
[95]Veazey RS, Lackner AA:Getting to the guts of HIV pathogenesis. J Exp Med 2004; 200:697-700.
[96]Veazey RS, Tham IC, Mansfield KG, et al. Identifying the target cell in primary simian immunodeficiency virus (SIV) infection:highly activated memory CD4 T cells are rapidly eliminated in early SIV infection in vivo. J Virol 2000;74:57-64.
[97]Veazey RS, Lackner AA:Getting to the guts of HIV pathogenesis. J Exp Med 2004; 200:697-700.
[98]Mehandru S, Poles MA, Tenner-Racz K, et al. Primary HIV-1 infection is associated with preferential depletion of CD4+T lymphocytes from effector sites in the gastrointestinal tract. J Exp Med 2004; 200:761-70.
[99]Brenchley JM, Schacker TW, Ruff LE, et al.CD4 T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract. J Exp Med 2004;200:749-59.
[100]Brenchley JM, Price DA, Douek DC. HIV disease:fallout from a mucosal catastrophe? Nat Immunol 2006; 7:235-9.
[101]Li Q, Schacker T, Carlis J, et al. Functional genomic analysis of the response of HIV-1-infected lymphatic tissue to antiretroviral therapy. J Dis 2004; 189:572-82.
[102]Bradley MN, Zhou L, Smale ST:C/EBPbeta regulation in lipopolysac-charide-stimulated macrophages. Mol Cell Biol 2003;23:4841-58.
[103]李梦东.艾滋病相关性腹泻.世界华人消化杂志,2001;9(8)：937-938.
[104]贾新亭,付芳玉,郭震,等.中药治疗艾滋病腹泻探讨.亚太传统医药,2007;3(7)：60-61.
[105]憨兰.半夏泻心汤治疗艾滋病的临床运用与体会.中医研究,2007;20(6)：55-56.
[106]潘金丽,徐立然,唐静文,等.半夏泻心汤加味治疗艾滋病腹泻20例.中医研究,2007;20(6)：46-47.
[107]赵晓梅,吕维柏,关茂桧.半夏泻心汤治疗艾滋病腹泻辨证体会.中国中医药信息杂志,1997：4(5)：41.
[108]李敏,马炳全.艾灸结合西药治疗艾滋病腹泻的疗效观察.上海针灸杂志,1999：18(5)10.
[109]李锦明.艾灸治疗艾滋病病人腹泻症60例.云南中医中药杂志,1997;18(2)：29.
[110]郭燕,钱宝延.艾灸治疗艾滋病腹泻65例临床观察.光明中医,2008：23(1)：27-28.
[111]郭燕,钱宝延.艾灸治疗艾滋病腹泻60例临床观察.河南中医学院学报,2005：20(4)：6-7.
[112]崔敏.艾滋病相关性腹泻中医治疗研究进展.云南中医中药杂志,2007：28(5)：49-50.
[113]陈海凤.浅谈中医药与免疫.光明中医,2003;18(107)：6.
[114]丁洋.艾滋病慢性腹泻中医证候研究.北京：北京中医药大学.
[115]屈冰,张明利,张书亮.半夏泻心汤治疗艾滋病相关腹泻68例.中医研究,2008：21(8)：37-38.
[116]杨国红,崔敏,周立华,等.参苓白术散治疗艾滋病相关性腹泻疗效观察.中华中医药学刊,2008：26(1)：150-153.
[117]潘金丽. 升阳益胃汤治疗艾滋病腹泻伴发热10例.中医研究,2009：22(1)：45-46.
[118]周艺彪,姜庆五,赵根明.调查研究中数据缺失的机制及处理方法.中国卫生统计,2005；22(5)：318-321.
[119]武建虎,贺佳,贺宪民,等.多变量缺失数据的不同处理方法及分析结果比较.第二军医学学报,2004;25(9)：1013-1016.
[120]颜虹.医学统计学.北京：人民卫生出版社,2005.
[121]王承,王学文.人免疫缺陷病毒感染的血液学特征.国外医学输血与血液学分册,1999：22(4)：245-248.
[122]张德迎,赵家平,骆云鹏,等.艾滋病相关性消化道吸收不良的研究概况.国外医学临床生物化学与检验学分册,2002;23(3)：168-169.
[123]赵勤,张会芬,李丽华,等.40例艾滋病病例外周血细胞及骨髓细胞异常改变.实用医技杂志,2007：14(34):4682-4684.
[124]王书时,陈琪,林榕,等.艾滋病患者15例姐液改变观察.实用医学杂志,2002：18(12)：1326-1328.
[125]岳云璇.42例HIV感染／艾滋病患者血液学改变.海南医学,2002;13(1)：58-59.
[126]朱根法,张小亿,朱燕,等.498例老年人脑出血并发多器官衰竭临床分析.急诊医学1999;8(1)：34.
[127]刘爱武.脑出血的多脏器功能衰竭40例.临床荟萃,1999;14(6)：256.
[128]Mwau M, Me Miehael AJ, et al. Areview of vaccines for HIV prevention. Gene Med,2003; 5 (2):3.
[129]Brandtzacg P. The secretory immunoglobulin system:regulation and biogical significance, Focusing on human mammary gland. Adv Exp Mcd Biol,2002;503(4):1-16.
[130]曾耀英,肇静娴.HIV病发病学新概念：肠淋巴组织主要病灶论.中国病理生理杂志,2005：21(3)：607-613.
[131]Verhoeven D, Sankaran S, Dandekar S. Sinfian immunodeficiency virus infection induces sev ere loss of intestinal central memory Tcells which impairs CIM T-cell restoration during antiretroviral therapy. J Med Primatol,2007;36(4-5):219.
[132]Verhoeven D, Sankaran S, Silvey M, et al. Antiviral therapy during primary simian immunodeficiency virus infection fails to prevent acute loss of CIM T cells in gut nlucosa but enhances their rapid restoration through central memory T cells. J Virol,2008;82(8):4016.
[133]Li Q, Estes JD, Duan L, et al. Simian immunodeficiency virus-induced intestinal cell apoptosis is the underlying mechanism of the regenerative enteropathy of early infection. J Infect Dis,2008; 197(3) :420.
[134]何金洋,符林春,周红燕.从肠道艾滋病毒感染机制试论艾滋病的中医辨治思路.广州中医药大学学报,2009：26(5):495-496.
[135]Macpherson A J. Uhr T. Induction of protective IgA by intestinal dendritic cells carrying commensal acteria. Science,2004;303(5664): 1662-1665.
[136]Stenstad H, Svensson M, Cucak H, et al. Differential homing mechanisms regulate regionalized effector CD8 alphbeta+T cell accumulation within the small intestine. Proc Natl Acad Sci USA,2007;104(24):10122-10127.
[137]李发枝,徐立然,李柏龄.中医学对艾滋病病因病机的认识.中医杂志,2006;47(5)：395-396.
[138]修宗昌,罗云坚,余绍源.中医脾胃学说中免疫思想探析.上海中医药杂志,2003：37(7)：3-6.
[139]李雁,闫晓天.益中蠲毒浓缩丸对脾虚小鼠免疫功能的影响.中国中西医结合消化杂志,2001：9(2)：79.
[140]章梅,张仲海,夏天,等.四君子汤对脾虚病例可溶性细胞粘附分子-1水平和单核细胞功能的影响.中国中西医结合杂志,1999;19(5):207.
[141]吴玲霓,雷娓娓,杨冬梯,等.肾虚、脾虚造型动物免疫超微结构的比较研究.中医药研究,1999：15(3)：39-40.
[142]李庆阳,郑家铿.老年肾虚T细胞亚群关系.福建中医学院学报,2001：11(2)：5-6.
[143]王培训,周联,潘华新,等.补肾健脾方药免疫药理作用比较.中药新药与临床药理,1998：9(2)：84-6.
[144]沈自尹,郑振,郭为民,等.补肾法延缓免疫衰老的临床与实验研究.中国中西医结合杂志,2002；22(3)：178-81.
[145]陈瑜,沈自尹,陈伟华,等.补肾与健脾复方调节皮质酮鼠T细胞凋亡的对比研究.中国中西医结合杂志,2002;22(6):444-6.
[146]张云飞,文秀华,罗茂林.肾虚本质的现代研究进展.现代中西医结合杂志,2004;13(8)：1101-1103.
[2]NACO report on AIDS in India 2004 [http://www. naco. gov. in].
[3]World Health Organization:Acquired immunodeficiency syndrome (AIDS): interim proposal for a WHO staging system for HIV infection and disease. Wkly Epidem Rec,1990;65:221-4.
[4]Lew EA, Poles MA, Dieterich DT. Diarrheal disease associated with HIV infection. Gastroenterol Clin North Am,1997;26:259-290.
[5]全海燕.38例艾滋病的临床分析.当代医学,2006;(11)：85-86.
[6]陈筱纯,吕晓菊,叶慧,等.HIV/AIDS感染者109例临床分析.中国感染与化疗杂志,2008：8(3)：183-186.
[7]张复春,唐小平.广州地区108例艾滋病临床流行病学特征分析.热带医学杂志,2002：2(4)：429-431.
[8]李梦东.艾滋病相关性腹泻.世界华人消化杂志,2001;9(8)：937-938.
[9]法科学家发现艾滋病病毒新亚型.生物学教学,2010;35(1)：78.
[10]王维真,刘康迈,危剑安,等.艾滋病临床治疗与护理培训教材.北京：北京大学医学出版社,2003,第1版：12-16.
[11]Ameisen JC. Capron A. Cell dysfunction and depletion in AIDS:The programmed cell deathhypothesis. Immunol Today,1991;12:102-105.
[12]池莉,水波,张永容.艾滋病发病机制中的细胞凋亡理论.中国实验动物学杂志,2000：10(4)：245-249.
[13]刘水青,徐斌,吴吴.HIV感染的免疫发病机制和免疫重建.国外医学·流行病学传染病学分册,2003,30(12)：323-325.
[14]Silvestri G, Feinberg MB. Turnover of lymphoeytes and conceptual paradigms in HIV infection. J Clin Invest,2003;112:821-824.
[15]曾耀英.HIV感染发病学的新概念.河南中医学院学报,2005;20(119)：1-5.
[16]李太生,王爱霞,邱志峰.艾滋病的免疫发病机制和免疫重建.中华医学杂志,2001：81(5)：310-312.
[17]Eggena MP, Barugahare B, Jones N, et al. Depletion of regulatory T cells intheHIVinfectionisassociatedwithimmuneactivation. Immunol,2005; 174: 4407-4414.
[18]汪习成,吴吴.HIV-1的潜伏储藏库.国外医学(流行病学传染病学分册),2001：28：6-10.
[19]Pope M, Haase AT. Transmission acute HIV-1 infection and the quest for strategies to prevent infection. Nat Med,2003;9:847-852.
[20]焦艳梅,吴昊.HIV-1潜伏库研究进展.首都医学大学学报,2009;30(5)：639-641.
[21]加、美科学家发现艾滋病病毒在人体内藏身之地-记忆T细胞,有助于研发治愈艾滋病的新方法.生物学教学,2010;35(1)：78-79.
[22]Stoiber H, Kacani L, Speth C, et al. The supportive role of complement in HIV pathogenesis. Immunol Rev,2001;180:168-176.
[23]张淑玲,罗端德.艾滋病的发病机制和病理改变.新医学,2006;37(1)：11-13.
[24]李海英,吴昊.HIV致病机制研究进展从中医理论谈艾滋病的发病机制.中国病原生物学杂志,2008：3(3)：227-229.
[25]赵树珍.艾滋病中医证治探讨.浙江中医杂志.1989；24(10)：435.
[26]孙利民,危剑安,黄霞珍,等.从中医理论谈艾滋病的发病机制.中华中医药杂志,2005;20(2)：100-101.
[27]王小平,刘颖,张永祥,等.艾乃吉Ⅰ号抗艾滋病的实验研究.山东中医杂志,2006：25(7)：474-476.
[28]蒋心悦.浅析爱滋病的病因病机.中国医药学报,2001;16(6)：41-42.
[29]郭选贤,谢世平,孙林,等.艾滋病中医病因病机研究概况.中医研究,2007：20(5)：59-61.
[30]张苑莉.中医治疗艾滋病的理论基础和方法的探讨.天津中医,1994;11(2)：46.
[31]黄炳山.中医治疗艾滋病.哈尔滨：黑龙江科学技术出版社,1990：25.
[32]胡建华,李秀惠,刘翠娥,等.100例艾滋病病例中医辨证分型研究.北京中医,2007：26(2)：97-98.
[33]赵晓梅,吕维柏.中医药治疗艾滋病的临床探析.中医杂志,1996;37(8)：499.
[34]陈听,田春,陈玉珍.223例HIV/AIDS病例不同分期中医舌象分析与病机探讨.中国中医药信息杂志,2008;15(12)：20-22.
[35]陈秀敏.艾滋病发热的火罐应用及辨证施护.光明中医,2009;24(8)：1580-1581.
[36]罗玲,李太生.AIDS抗病毒治疗的历史、现状与未来.传染病信息,2009：22(6)：321-324.
[37]张颖,白雪帆,孙永涛.抗人类免疫缺陷病毒-1基因治疗的新进展.中华传染病杂志,2005;23(1)：61-63.
[38]中成药唐草片获得批准用于改善艾滋病症状.中国中医药信息杂志,2004：11(5)：466.
[39]危剑安,金燕,陈宇霞,等.艾灵颗粒治疗18例HIV/AIDS病例12个月临床总结.传染病信息,2006;19(5)：256-258.
[40]田圣志,张怀亮,施钧瀚,等.爱可扶正片治疗HIV/AIDS112例3年临床疗效总结.世界中西医结合杂志,2009;4(1)：23-25.
[41]黄卫平,王健,于智敏,等.艾通治疗艾滋病病毒感染及艾滋病病例15例.中国中医药信息杂志,2002：9(11)：49-50.
[42]王健,于智敏,李国勤,等.中研2号治疗艾滋病病毒感染及艾滋病病例29例临床观察.2001：42(7)：418-420.
[43]马伯艳,符林春,陈谐捷,等.艾可清胶囊治疗获得性免疫缺陷综合征疗效分析.中医杂志,2007：48(12)：1092-1094.
[44]张苗苗,符林春,蔡卫平,等.艾可清胶囊对HIV感染者的疗效观察.中华中医药学刊,2008：26(10)：2233-2236.
[45]曹廷智,刘水滕,王辉,等.艾可清联合HAART治疗艾滋病30例临床观察.中国医药前沿,2008：3(20)：1-4.
[46]张骁,雍晓春,张韬.艾滋病疫苗研发最新进展.中国制药信息,2010;26(1)：6-16.
[47]http:／／www.chinadaily.com.cn／hqgj／2009—09／25／content_8734652.htm. 2009／9／25.
[48]http:／／www.cavax.org／newsview.asp?id=355.2010／3／26.
[49]龙渊,杨小洁,赵淑雯.辨证分型治疗腹泻55例疗效观察.云南中医中药杂志,2006：27(4)：6-7.
[50]丁远富.慢性腹泻的中西医结合诊治.中华实用中西医杂志,2006;19(16)：1975.
[51]李海强,贝光明,周翼,等.249例慢性腹泻病例血液流变学及结肠镜检查分析.中医研究,2009：22(3)：36-38.
[52]郁晓维,王丽慧,王明明.迁延性腹泻中医证型探讨.时珍国医国药,2007;18(4)：968-969.
[53]陆海英,霍娜,童一帆,等.S ARS伴腹泻病例的临床特点.世界华人消化杂志,2003：11(12)：1929-1931.
[54]韩晓群,韩晓青,徐德翠.肝源性腹泻29例分析.中西医结合肝病杂志,2007：17(3)：178-179.
[55]沈培源,吴德平.肝源性腹泻的中医辨治.长春中医学院学报,2002;18(1)：1 8.
[56]翟亭立,薛庆光.肠易激综合征及其中医证型与胃肠激素的相关性研究.基层医学论坛,2010：14：85-86.
[57]王丽华,董宏生,李颖辰,等.肠易激综合征中医证型血中胃肠激素水平初探.中医药学刊,2005;23(9)：1618-1619.
[58]舒士敏,顾洁.辨证治疗腹泻型肠易激综合征50例.河北中医,2009：31(7)：989.
[59]许成群.糖尿病性腹泻的中医病机浅析.陕西中医学院学报,2004;27(3)：7-8.
[60]王文成,郭勇.中医药治疗化疗相关性腹泻的研究述略.实用中医内科杂志,2008：22(10)：79-81.
[61]马纯清.四君子汤合四神丸加减治疗慢性腹泻临床观察.光明中医,2009：24(11)：2119-2120.
[62]姜敏.中医辨证治疗糖尿病性腹泻43例.河北中医,2007;29(11)：1037.
[63]张志明.加味实脾饮治疗抗生素相关性腹泻90例临床观察.卫生职业教育,2009：27(15)：138-139.
[64]高培阳,王春霞.中医药治疗抗生素相关性腹泻30例分析.实用中西医结合临床,2007：7(5)：20-21.
[65]陈建新.温补脾肾法治疗慢性腹泻 36例. 实用中医内科杂志,2008：22(6)：36.
[66]李虹.健脾益肾法治疗慢性腹泻43例.陕西中医,2005,26(9)：921.
[67]祁江宁.祛寒除湿法治疗非感染性腹泻体会.光明中医,2007;22(12);23-25.
[68]Sanchez TH, Brooks JT, Sullivan PS, et al. Bacterial diarrhea in persons with HIV infection, United States,1992-2002. Clin Infect Dis,2005; 41(11):1621-1627.
[69]Rebecca A, Dillingham, Relana Pinkerton, et al. Pinkerton High Early Mortality in Patients with Chronic Acquired Immunodeficiency Syndrome Diarrhea Initiating Antiretroviral Therapy in Haiti:A Case-Control Study. Am. J. Trop. Med. Hyg.,2009; 80 (6):1060-1064.
[70]Assi M, McKinsey DS, Driks MR, et al. Gastrointestinal histoplasmosis in the acquired immunodeficiency syndrome:report of 18 cases and literature review. Diagn Microbiol Infect Dis,2006;55(3):195-201.
[71]彭继承,罗宜辉,李运泽.以腹泻为主要临床表现的艾滋病37例分析.中国实用医药,2009：4(31)：66-67.
[72]Garro S, Bava AJ. Cryptococcus neoformans in the gastric contents of an AIDS patient. Rev Argent Microbiol,2006;38(4):206-208.
[73]Ukarapol N, Chartapisak W, Lertprasertsuk N, et al. Cytomegalovirus-a ssociated manifestations involving the digestive tract in children with human immunodeficiency virus infe ction. J Pediatr Gastroenterol Nutr,2002; 35 (5):669-673..
[74]GuarinoA, Bruzzese E, De Marco G, et al. Management of gastrointestinal disorders in children with HIV infection. Paediatr Drugs, 2004; 6 (6):347-362.
[75]Dillingham RA, Lima AA, Guerrant RL. Cryptosporidiosis:epidemiology and impact. Microbes Infect.2002;4(10):1059-1066.
[76]Kuppamuthu Ramakrishnan, Rajaiah shenbagarathai, Alagappan Uma, et al. Prevalence of intestinal parasitic infestation in HIV/AIDS patience with Diarrhea in Madurai City, Sourth, India. Jpn. J. Infect. Dis.2007;60:209-210.
[77]Ramakrishnan K, Shenbagarathai R, Uma A, et al. Prevalence of intestinal parasitic infestation in HIV/AI DS patients with diarrhea in Madurai City, South India. Jpn J Infect Dis,2007;60(4):209-210.
[78]Dwivedi KK, Prasad G, Saini S, et al. Enteric opportunistic parasites among HIV infected individuals associated risk factors and immune status. Jpn J Infect Dis,2007;60(2-3):76-81.
[79]Rossit AR, de Almeida MT, Nogueira CA, et Al. Bacterial, yeast, parasitic, and viral enteropathogens in HIV-infected children from Sao Paulo State, Soutlleastern Brazil. Diagn Microbiol Infect Dis,2007; 57(1):59-66.
[80]Rebecca A, Dillingham, Relana Pinkerton, et al. High Early Mortality in Patients with Chronic Acquired Immunodeficiency Syndrome Diarrhea Initiating Antiretroviral Therapy in Haiti:A Case-Control Study. Am. J. Trop. Med. Hyg,2009; 80 (6):1060-1064.
[81]Brink AK, Mahe C, Watera C, et al. Diarrhea, CD4 counts and enteric infections in a community-based cohort of HIV-infected adults in Uganda. J Infect.2002;45(2):99-106.
[82]李坪,毛羽,兰孟东,等.HIV(+)非特异性慢性结肠炎腹泻病例结肠黏膜血管的改变.世界华人消化杂志.2008：16(14)：1530-1534.
[83]韦浪曲.艾滋病病例11例肠镜特征分析.临床内科杂志,2008;25(5)：304.
[84]周锦,张晶,徐樨巍.表现为慢性腹泻的儿童艾滋病7例.实用儿科临床杂志,2008：23(10)：763-764.
[85]杨克利,龙翠英.AIDS并慢性腹泻的血液学变化与死亡的关系.中国误诊学杂志,2005：5(15)：2818-2819.
[86]Suresh VS Attili.AK Gulati, VP Singh. Et al. Diarrhea, CD4 counts and enteric infections in a hospital-based cohort of HIV-infected patients around Varanasi, India. BMC Infectious Diseases.2006;6:39.
[87]Derouin, Francisl; Lagrange-Xelot, et al. Treatment of parasitic diarrhea in HIV-infected patients.2008;6(3):337-349.
[88]Frederic Clayton, Donald P. Kotler, Scott K. Kuwada, et al. A Possible Cause of Human Immunodeficiency Virus Enteropathy. American Journal of Pathology,2001;159(5):1933-9.
[89]Dayanithi G, Yahi N, Baghdiguian S, et al. Intracellular calcium release induced by human immunodeficiency virus type 1 (HIV-1) surface envelope glycoprotein in human intestinal pithelial cells:a putative mechanism for HIV-1 enteropathy. Cell Calcium 1995; 18:9-18.
[90]Delezay 0, Yahi N, Tamalet C, et al. Direct effect of type 1 human immunodeficiency virus (HIV-1) on intestinal epithelial cell differenti-ation:relationship to HIV-1 enteropathy. Virology 1997; 238:231-242.
[91]Stockmann M, Schmitz H, Fromm M, et al. Mechanisms of epithelial barrier impairment in HIV infection. Ann N Y Acad Sci.2000;915:293-303.
[92]Schmitz H, Rokos K, Florian P, et al. Supernatants of HIV-infected immune cells affect the barrier function of human HT-29/B6 intestinal epithelial cells. AIDS.2002; 16(7):983-91.
[93]Mehandru S, Poles MA, Tenner-Racz K, et al. Primary HIV-1 infection is associated with preferential depletion of CD4 T lymphocytes from effector sites in the gastrointestinal tract. J Exp Med 2004; 200:761-770.
[94]Brenchley JM, Schacker TW, Ruff LE, et al. CD4 T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract. J Exp Med 2004;200:749-759.
[95]Veazey RS, Lackner AA:Getting to the guts of HIV pathogenesis. J Exp Med 2004; 200:697-700.
[96]Veazey RS, Tham IC, Mansfield KG, et al. Identifying the target cell in primary simian immunodeficiency virus (SIV) infection:highly activated memory CD4 T cells are rapidly eliminated in early SIV infection in vivo. J Virol 2000;74:57-64.
[97]Veazey RS, Lackner AA:Getting to the guts of HIV pathogenesis. J Exp Med 2004; 200:697-700.
[98]Mehandru S, Poles MA, Tenner-Racz K, et al. Primary HIV-1 infection is associated with preferential depletion of CD4+T lymphocytes from effector sites in the gastrointestinal tract. J Exp Med 2004; 200:761-70.
[99]Brenchley JM, Schacker TW, Ruff LE, et al.CD4 T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract. J Exp Med 2004;200:749-59.
[100]Brenchley JM, Price DA, Douek DC. HIV disease:fallout from a mucosal catastrophe? Nat Immunol 2006; 7:235-9.
[101]Li Q, Schacker T, Carlis J, et al. Functional genomic analysis of the response of HIV-1-infected lymphatic tissue to antiretroviral therapy. J Dis 2004; 189:572-82.
[102]Bradley MN, Zhou L, Smale ST:C/EBPbeta regulation in lipopolysac-charide-stimulated macrophages. Mol Cell Biol 2003;23:4841-58.
[103]李梦东.艾滋病相关性腹泻.世界华人消化杂志,2001;9(8)：937-938.
[104]贾新亭,付芳玉,郭震,等.中药治疗艾滋病腹泻探讨.亚太传统医药,2007;3(7)：60-61.
[105]憨兰.半夏泻心汤治疗艾滋病的临床运用与体会.中医研究,2007;20(6)：55-56.
[106]潘金丽,徐立然,唐静文,等.半夏泻心汤加味治疗艾滋病腹泻20例.中医研究,2007;20(6)：46-47.
[107]赵晓梅,吕维柏,关茂桧.半夏泻心汤治疗艾滋病腹泻辨证体会.中国中医药信息杂志,1997：4(5)：41.
[108]李敏,马炳全.艾灸结合西药治疗艾滋病腹泻的疗效观察.上海针灸杂志,1999：18(5)10.
[109]李锦明.艾灸治疗艾滋病病人腹泻症60例.云南中医中药杂志,1997;18(2)：29.
[110]郭燕,钱宝延.艾灸治疗艾滋病腹泻65例临床观察.光明中医,2008：23(1)：27-28.
[111]郭燕,钱宝延.艾灸治疗艾滋病腹泻60例临床观察.河南中医学院学报,2005：20(4)：6-7.
[112]崔敏.艾滋病相关性腹泻中医治疗研究进展.云南中医中药杂志,2007：28(5)：49-50.
[113]陈海凤.浅谈中医药与免疫.光明中医,2003;18(107)：6.
[114]丁洋.艾滋病慢性腹泻中医证候研究.北京：北京中医药大学.
[115]屈冰,张明利,张书亮.半夏泻心汤治疗艾滋病相关腹泻68例.中医研究,2008：21(8)：37-38.
[116]杨国红,崔敏,周立华,等.参苓白术散治疗艾滋病相关性腹泻疗效观察.中华中医药学刊,2008：26(1)：150-153.
[117]潘金丽. 升阳益胃汤治疗艾滋病腹泻伴发热10例.中医研究,2009：22(1)：45-46.
[118]周艺彪,姜庆五,赵根明.调查研究中数据缺失的机制及处理方法.中国卫生统计,2005；22(5)：318-321.
[119]武建虎,贺佳,贺宪民,等.多变量缺失数据的不同处理方法及分析结果比较.第二军医学学报,2004;25(9)：1013-1016.
[120]颜虹.医学统计学.北京：人民卫生出版社,2005.
[121]王承,王学文.人免疫缺陷病毒感染的血液学特征.国外医学输血与血液学分册,1999：22(4)：245-248.
[122]张德迎,赵家平,骆云鹏,等.艾滋病相关性消化道吸收不良的研究概况.国外医学临床生物化学与检验学分册,2002;23(3)：168-169.
[123]赵勤,张会芬,李丽华,等.40例艾滋病病例外周血细胞及骨髓细胞异常改变.实用医技杂志,2007：14(34):4682-4684.
[124]王书时,陈琪,林榕,等.艾滋病患者15例姐液改变观察.实用医学杂志,2002：18(12)：1326-1328.
[125]岳云璇.42例HIV感染／艾滋病患者血液学改变.海南医学,2002;13(1)：58-59.
[126]朱根法,张小亿,朱燕,等.498例老年人脑出血并发多器官衰竭临床分析.急诊医学1999;8(1)：34.
[127]刘爱武.脑出血的多脏器功能衰竭40例.临床荟萃,1999;14(6)：256.
[128]Mwau M, Me Miehael AJ, et al. Areview of vaccines for HIV prevention. Gene Med,2003; 5 (2):3.
[129]Brandtzacg P. The secretory immunoglobulin system:regulation and biogical significance, Focusing on human mammary gland. Adv Exp Mcd Biol,2002;503(4):1-16.
[130]曾耀英,肇静娴.HIV病发病学新概念：肠淋巴组织主要病灶论.中国病理生理杂志,2005：21(3)：607-613.
[131]Verhoeven D, Sankaran S, Dandekar S. Sinfian immunodeficiency virus infection induces sev ere loss of intestinal central memory Tcells which impairs CIM T-cell restoration during antiretroviral therapy. J Med Primatol,2007;36(4-5):219.
[132]Verhoeven D, Sankaran S, Silvey M, et al. Antiviral therapy during primary simian immunodeficiency virus infection fails to prevent acute loss of CIM T cells in gut nlucosa but enhances their rapid restoration through central memory T cells. J Virol,2008;82(8):4016.
[133]Li Q, Estes JD, Duan L, et al. Simian immunodeficiency virus-induced intestinal cell apoptosis is the underlying mechanism of the regenerative enteropathy of early infection. J Infect Dis,2008; 197(3) :420.
[134]何金洋,符林春,周红燕.从肠道艾滋病毒感染机制试论艾滋病的中医辨治思路.广州中医药大学学报,2009：26(5):495-496.
[135]Macpherson A J. Uhr T. Induction of protective IgA by intestinal dendritic cells carrying commensal acteria. Science,2004;303(5664): 1662-1665.
[136]Stenstad H, Svensson M, Cucak H, et al. Differential homing mechanisms regulate regionalized effector CD8 alphbeta+T cell accumulation within the small intestine. Proc Natl Acad Sci USA,2007;104(24):10122-10127.
[137]李发枝,徐立然,李柏龄.中医学对艾滋病病因病机的认识.中医杂志,2006;47(5)：395-396.
[138]修宗昌,罗云坚,余绍源.中医脾胃学说中免疫思想探析.上海中医药杂志,2003：37(7)：3-6.
[139]李雁,闫晓天.益中蠲毒浓缩丸对脾虚小鼠免疫功能的影响.中国中西医结合消化杂志,2001：9(2)：79.
[140]章梅,张仲海,夏天,等.四君子汤对脾虚病例可溶性细胞粘附分子-1水平和单核细胞功能的影响.中国中西医结合杂志,1999;19(5):207.
[141]吴玲霓,雷娓娓,杨冬梯,等.肾虚、脾虚造型动物免疫超微结构的比较研究.中医药研究,1999：15(3)：39-40.
[142]李庆阳,郑家铿.老年肾虚T细胞亚群关系.福建中医学院学报,2001：11(2)：5-6.
[143]王培训,周联,潘华新,等.补肾健脾方药免疫药理作用比较.中药新药与临床药理,1998：9(2)：84-6.
[144]沈自尹,郑振,郭为民,等.补肾法延缓免疫衰老的临床与实验研究.中国中西医结合杂志,2002；22(3)：178-81.
[145]陈瑜,沈自尹,陈伟华,等.补肾与健脾复方调节皮质酮鼠T细胞凋亡的对比研究.中国中西医结合杂志,2002;22(6):444-6.
[146]张云飞,文秀华,罗茂林.肾虚本质的现代研究进展.现代中西医结合杂志,2004;13(8)：1101-1103.