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目的提高对人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(艾滋病)相关性心肌病早期临床与病理特点的认识。方法分析2010年2月收治的1例艾滋病合并扩张型心肌病患者的临床资料及诊治经过,并复习相关文献。结果患者,男,41岁;临床表现为发热,咳嗽,咳痰,气短;HIV-1抗体阳性;超声心动图示:扩张型心肌病样改变:全心扩大、左室壁运动幅度弥漫性减低,左心功能不全,左室限制性充盈,左室腔内强回声光团(考虑附壁血栓),肺动脉高压(轻-中度),二尖瓣返流(少量),三尖瓣返流(中量),心包积液(少量),下腔静脉增宽。符合艾滋病合并扩张型心肌病的诊断。本例的特点与文献报道的HIV相关性心肌病相一致。结论 HIV相关性心肌病的临床特征缺乏特异性,目前尚无统一的诊断和治疗方法,心电图和超声心动图可作为早期筛查手段,静脉注射丙种球蛋白是主要的治疗措施,高效抗逆转录病毒治疗可显著降低HIV相关性心肌病的发生率。
Objective To raise awareness of early clinical and pathological features of HIV-related / acquired immunodeficiency syndrome (AIDS)-related cardiomyopathy. Methods The clinical data, diagnosis and treatment of one case of AIDS with dilated cardiomyopathy admitted in February 2010 were analyzed and the related literatures were reviewed. Results The patient, male, 41 years of age; clinical manifestations of fever, cough, sputum, shortness of breath; positive for HIV-1 antibody; echocardiography: dilated cardiomyopathy-like changes: total heart enlargement, diffuse loss of left ventricular wall motion , Left ventricular dysfunction, left ventricular confinement filling, left echocardiographic hyperechoic (consider mural thrombus), pulmonary hypertension (mild to moderate), mitral regurgitation (minor), tricuspid regurgitation Flow (volume), pericardial effusion (a small amount), inferior vena cava widened. In line with AIDS diagnosis of dilated cardiomyopathy. The characteristics of this case are consistent with those of HIV-associated cardiomyopathy reported in the literature. Conclusion The clinical features of HIV-related cardiomyopathy are lack of specificity. There is no uniform diagnosis and treatment methods. ECG and echocardiography can be used as early screening methods. Intravenous gamma globulin is the main treatment measure, high-efficiency anti-retroviral transcription Virus treatment can significantly reduce the incidence of HIV-related cardiomyopathy.