爱华网艾滋病所致中枢神经系统感染
获得性免疫缺陷综合征，简称艾滋病(Acqtlired Immtmodeficieneg Syndrome，AIDS)是人类免疫缺陷病毒引起的人体细胞免疫缺陷，导致一系列致病菌感染和肿瘤发生的致命性综合征。约30％的艾滋病人可有神经系统损害，1／lO为其首发症状，尸检有80％以上有神经系统病变。由于本病的传染性强，死亡率高，号称“超级癌症”，已被世界各国普遍重视，构成当今世界最严重的社会问题之一。无论任何人，特别是医务工作者，只要生活在这个时代，就必须对此病有充分认识。 艾滋病的传播途径主要是通过性交和静脉注射。其流行病学类似乙型病毒性肝炎，病毒存在于血液、尿液、汗液、唾液和精液中。大量的流行病学资料表明，艾滋病的高发人群包括：同性恋者、静脉用药(指麻醉毒品)者、海地人、经常接受输血或血制品者，与高发人群接触的妇女所生的婴儿等。 【艾滋病所致中枢神经系统感染的病因病理】 一、西医病因病机 艾滋病是由一种亲淋巴细胞的逆转录病毒引起的。1983年法国巴斯德研究所．Montagmi—er等首先分离出一种病毒，命名为淋巴腺病综合征相关病毒(LAV)。1984年美国国立肿瘤研究所callo艾滋病人体内分离出一种新的逆转录病毒，人类嗜T淋巴细胞Ⅲ型病毒(HTLV 一Ⅲ)，此后的研究表明，这两种病毒是引起艾滋病的同一类病毒的变种，曾命名为LAV／HTLV 一Ⅲ。1986年国际病毒分类委员会正式定名为人类免疫缺陷病毒(HIV)，现将最早发现的HIV称为HTLV 一Ⅲ，以后又发现了HTLV 一Ⅲ，它与HTLV 一Ⅲ(即HIV)在某些特性上有所不同。最近已从艾滋病患者的脑脊液和脑组织中分离出HTLV 一Ⅲ，从一些和艾滋病有关的非化脓性脑膜炎、亚急性脑炎、脊髓病变和周围神经中也分离出该病毒，说明它是亲神经I生的。而且在艾滋病人血清、脑脊液中测出了抗HTLV 一Ⅲ抗体，其阳性率达100％，96％的病人在脑脊液中有特异的单克隆抗体IgG，表明抗体是在鞘内合成的。这种病毒也可在周围单核细胞中生长成一种RNA病毒，携带有逆转录酶。它与淋巴细胞，尤其是T4细胞有极强的亲和力。感染后可在T4细胞中复制，按其形态、基因和分类学，htlv 像Visna病毒，可致进行性脑病，潜伏期一般为3年，但病毒血症往往大于3年。据统计，艾滋病的感染率远远大于其发病率，两者之比约为50：1，可用酶联免疫吸附试验(ELISA)测定血清或脑脊液中的抗HTLV一Ⅲ抗体。如阳性，表明有感染，但不表明是否发病。 艾滋病毒通过性接触传染，经污染的血液、血液制品、针头注射器传染或母婴传播，感染了艾滋病毒后，该病毒主要攻击和破坏的靶细胞是辅助性T细胞(T4)，这种病毒对T4有亲和力，使之破裂、溶解、消失，从而使机体的T4减少，呈现免疫抑制状态，并易发生条件性感染及Kaposi肉瘤，这种病毒是嗜神经性的，易侵犯神经系统，感染脑和脊髓，出现神经系统症状。 二、中医病因病机 中医学认为本病为不洁性交后，感染“疫毒”邪气，其多属湿热秽浊毒气，迅速传内，损伤气血脏腑。主要表现为正气虚，以肾气亏虚为主，在免疫功能低下的情况下易导致疾病的发生。具体来说有以下几点： 由性行为途径，感染疫毒 疫毒通过精窍或皮毛黏膜内侵，气伏营入血或直人血分，累及脏腑。正虚毒盛，阴阳失调，脏气衰败。 湿热疫毒，伤气伏营人血 在正气不足，卫外抗邪不力之时，疫毒邪气乘机而人，首伤人之气分，迅而内伏营分，此时毒力不盛，正气尚可，病情一般不重，若疫毒邪气内伏营分，可耗伤营阴或壅遏营血。如疫毒太盛，可耗血动血，或毒火攻心，心神被扰。 正不胜邪，内脏虚衰 正气虚弱，疫毒内侵，更伤气血致使内脏虚衰，气血津液亏耗，最终导致五脏衰败。 脏气不调，内生痰核瘀血 疫毒内侵，脏腑气血亏虚，功能失调，常导致痰浊内聚，瘀血内停，产生痰核、瘰疬、癜积等。 最后，五脏虚极，气血津液耗竭，阴阳不能维系，则阴阳离绝而死亡。 【艾滋病所致中枢神经系统感染的调摄护理】 1．首先要学习有关艾滋病的基本知识，艾滋病是一种传染病，主要经性接触、输血、血液制品及母婴传播。应了解艾滋病的主要临床表现及措施。 2．做好患者的心理工作，在病情缓解期应让患者参与适当的社会工作，使患者心情愉快地工作与治疗。 3．患艾滋病的妇女应避免妊娠，以防经胎盘传给胎儿。 【艾滋病所致中枢神经系统感染的分证论治】 1．邪伤正气 (1)治法：清热解毒益气。 (2)方剂：银翘散合玉屏凤散加减。 (3)组成：金银花15g，连翘10g，板蓝根10g，桔梗6g，川贝母10g，牛蒡子9g，蒲公英15g，天花粉9g，防风6g，白术9g，人参10g，生甘草6g。 (4)备选方：败毒散。柴胡6g，前胡6g，川芎5g，枳壳5g，羌活6g，独活6g，桔梗5g，人参10g，甘草4g。 (5)加减：兼有手足心热、低热、干咳等加生地15g、麦冬10g、知母10g、玄参9g；如兼高热、神昏，以白虎加人参汤合用。 (6)临证事宜：注意保暖，慎防感冒。 2．邪热蕴肺 (1)治法：清热泻肺化痰。 (2)方剂：泻白散合麻杏石甘汤加减。 (3)组成：黄芩6g，桑白皮9g，知母6g，鱼腥草15g，瓜蒌9g，川贝母10g，苏子9g，橘红6g，石膏15g，杏仁9g，天竺黄6g。 (4)备选方：清气化痰丸。瓜蒌仁9g，陈皮6g，黄芩6g，杏仁8g，枳实9g，茯苓12g，胆南星9g，清半夏9g。 (5)加减：便秘者加大黄6g、火麻仁9g；尿痛者加木通9g。 (6)临证事宜：忌食辛辣刺激性食物。 3．热陷营血 (1)治法：清热凉血解毒。 (2)方剂：犀角地黄汤合清瘟败毒饮加减。 (3)组成：水牛角30g，羚羊角10g，生地黄20g，赤芍15g，丹皮9g，丹参12g，栀子9g，连翘9g，金银花12g，玄参9g，黄芩6g，紫草10g，石菖蒲6g，石膏15g。 (4)备选方：清营汤。水牛角30g，生地黄15g，玄参9g，竹叶心3g，麦冬9g，丹参6g，黄连5g，金银花9g，连翘6g。 (5)加减：如出现神昏、惊厥、抽搐等，可选用中成药“三宝”服用。 (6)临证事宜：体温过高可配合中药外洗以降温。 4．脾胃虚弱 (1)治法：健脾养胃补血。 (2)方剂：六君子汤加减。 (3)组成：黄芪15g，党参15g，白术12g，山药10g，茯苓12g，黄精10g，柴胡6g，陈皮6g，砂仁3g，当归9g，甘草5g。 (4)备选方：补中益气汤。黄芪15g，甘草5g，人参10g，当归10g，橘皮6g，升麻3g，柴胡3g，白术10g。 (5)加减：如心悸者合归脾汤加减，如久泻不止，腹痛者加制附子。 (6)临证事宜：患者应注意休息，饮食宜清淡且富于营养。 5．肾精不足 (1)治法：滋肾填精益阴。 (2)方剂：六味地黄丸合河车再造丸加减。 (3)组成：牛膝9g，紫河车10g，熟地黄10g，天门冬lOg，麦门冬lOg，阿胶10g，龟甲15g，鳖甲10g，白芍9g，五味子6g，肉苁蓉10g，玄参9g，山萸肉9g，丹皮6g。 (4)备选方：左归饮。熟地黄30g，山药6g，枸杞子6g，炙甘草3g，茯苓6g，山茱萸5g。 (5)加减：如低热、干咳、咽痛者，加重养阴润肺之品；如形寒肢冷，小便频数，加附子6g、肉桂8g、巴戟天12g。 (6)临证事宜：忌食辛辣之物。 6．肝肾阴虚 (1)治法：滋阴补肾养肝。
(2)方剂：六味地黄丸合二至丸加减。 (3)组成：熟地黄20g，山萸肉12g，山药10g，泽泻6g，丹皮6g，麦冬9g，鳖甲10g，枸杞子10g，酸枣仁10g，菊花6g，知母9g，当归9g，旱莲草9g，女贞子9g。 (4)备选方：一贯煎合大补阴丸加减。北沙参10g，麦冬10g，当归10g，生地黄30g，枸杞子12g，川楝子5g，黄柏6g，知母6g，龟甲18g。 (5)加减：眩晕欲仆合镇肝熄风汤加减。 (6)临证事宜：忌食辛辣刺激性食物，注意生活起居。 7．气阴两虚 (1)治法：益气养阴。 (2)方剂：黄芪生脉饮加减。 (3)组成：黄芪30g，党参15g，麦冬10g，五味子9g，知母9g，炒白芍9g，地骨皮9g，女贞子10g。 (4)备选方：炙甘草汤加减。炙甘草12g，人参6g，干地黄30g，桂枝10g，阿胶6g，麦门冬10g，麻仁20g，生姜10g，大枣10枚。 (5)加减：咳嗽、气短、恶风等肺气虚亏者，可合补肺汤加减。 (6)临证事宜：预防感冒，多饮水。 8．痰凝血瘀 (1)治法：祛痰消瘰化瘀。 (2)方剂：桃红四物汤加减。 (3)组成：桃仁10g，红花10g，赤芍9g，川芎6g，水牛角15g，胆南星9g，半夏9g，山慈菇9g，党参10g，蜈蚣2条，桔梗3g，白芥子6g，竹茹3g。 (4)备选方：消瘰丸合贝母瓜蒌散。玄参10g，牡蛎10g，贝母10g，瓜蒌3g，天花粉2g，茯苓2g，橘红2g，桔梗2g。 (5)加减：体质弱者可合用补气、滋阴、养血之品。 (6)临证事宜：保持愉快心情，忌食肥甘油腻。 【艾滋病所致中枢神经系统感染的鉴别诊断】 1．皮质类固醇、化疗、放疗或原先已经存在的恶性肿瘤及严重的蛋白质一热能性营养不良引起的继发性免疫缺陷病。 2．原发性免疫缺陷病。 3．血液病 由于艾滋病的患者有发热、肝脾肿大、淋巴结肿大，个别白细胞低、淋巴细胞减少。因此，临床上注意应和血液病进行鉴别。 4．中枢神经系统病变应注意与其他原因引起的中枢神经系统疾病相鉴别。 5．传染性单核细胞增多症艾滋病的高危人群出现传染性单核细胞增多症时，应即做HIV抗体检测。
AIDS due to the central nervous system infection
Acquired Immune Deficiency Syndrome, or AIDS (Acqtlired Immtmodeficieneg Syndrome, AIDS) is caused by human immunodeficiency virus in human cells, immune deficiency, leading to a series of pathogenic infections and tumors of the fatal syndrome. About 30% of AIDS may have nervous system damage, 1/lO its first symptom, more than 80% of the autopsy are the nervous system lesions. As a result of this infectious disease, and mortality rates, so-called "super cancer", has been generally great importance to all countries in the world, constitute the world‘s most serious social problems. Regardless of any person, especially medical workers, as long as the people living in this day and age, it is necessary to fully understand this disease. The main mode of transmission of AIDS through sexual intercourse and intravenous. Its epidemiology similar hepatitis B, the virus exists in the blood, urine, sweat, saliva and semen. A large number of epidemiological data indicate that high-risk population of AIDS include: homosexuals, intravenous drug use (referring to Narcotic Drugs), the Haitians, often receive a blood transfusion or blood products, and contacts with high-risk population of babies born to women and so on. 【AIDS infection due to the causes of the central nervous system pathology】 First, Western pathogenesis AIDS is caused by a pro-lymphocytes retroviral caused. Pasteur Institute in France in 1983. Montagmi-er, such as a virus first isolated and named as lymphadenopathy syndrome-associated virus (LAV). In 1984 the U.S. National Cancer Institute callo AIDS isolated from the human body, a new retrovirus, human T-lymphocytes Ⅲ virus (HTLV a Ⅲ), subsequent studies have shown that these two causes AIDS virus is the same type of viruses can mutate, has named the LAV / HTLV a Ⅲ. In 1986 the International Committee on Taxonomy of Viruses officially named human immunodeficiency virus (HIV), now known as the first HIV discovered HTLV a Ⅲ, after a discovery of HTLV Ⅲ, it HTLV a Ⅲ (ie HIV) in certain characteristics different. Recently, the cerebrospinal fluid from patients with AIDS and the brain tissue isolated HTLV a Ⅲ, and from a number of AIDS-related non-suppurative meningitis, sub-acute encephalitis, spinal cord and peripheral nerve lesions have also isolated the virus shows that it is pro - I raw nerve. AIDS but also in human serum, cerebrospinal fluid detected Ⅲ an anti-HTLV antibodies, the positive rate of 100%, 96% of patients in the cerebrospinal fluid have a specific monoclonal antibody IgG, showed that antibodies in the intrathecal synthesis. The virus can also be in the surrounding mononuclear cells grow into an RNA virus, carrying the reverse transcriptase. With lymphocytes, especially T4 cells have a strong affinity. Infected T4 cells can be copied, according to their morphology, genetics and taxonomy, htlv like Visna virus, can be induced to carry out encephalopathy incubation period is generally 3 years but viremia is often greater than 3 years. According to statistics, the AIDS infection rate is far greater than the incidence of both the ratio is about 50:1, available enzyme-linked immunosorbent assay (ELISA) in serum or cerebrospinal fluid of an anti-HTLV antibody Ⅲ. If positive, indicating that there are infections, but does not indicate whether the incidence. HIV through sexual contact, by contaminated blood, blood products, needles or syringes infected mother to child transmission, infected with HIV, the virus mainly attacks and destruction of target cells are T-cells (T4), this kind of virus affinity for T4 have to break down, dissolve, disappear, so that the body of T4 reduced, showing the state of immune suppression, and prone to infections and conditions of Kaposi sarcoma, the virus is neurotropic in nature, easy to violations of the nervous system, infection brain and spinal cord, neurological symptoms appear. Second, traditional Chinese medicine pathogenesis of Chinese medicine that the disease unclean sexual intercourse, the infection "疫毒" evil, the more gas is a hot and humid Turbidimetry Tourette quickly Chuan, the injury of blood and viscera. Qi deficiency is mainly manifested in order to kidney deficiency mainly in immunocompromised circumstances lead to diseases. Specifically the following points: By sexual means,疫毒疫毒infection through mucous membrane fine fur eyes or intrusion, gas V business straight into the blood or human blood points and organs involved. Are virtual drug-sheng, an imbalance of yin and yang, dirty gas decline. Hygrothermal疫毒injured volt gas business in the upright less than human blood, health and foreign anti-poor at the time of evil, evil疫毒opportunity and the people, the first assault on the gas points, while the inside Xun Fu business hours, when the virulence is not sung, righteousness can condition are generally not heavy, if the evil inside the V疫毒business hours, may be overcast耗伤business or business壅遏blood. If too疫毒Sheng, may consume the blood moving blood, or drugs火攻heart and mind have been scrambling. Are too evil and viscera failure righteousness virtual weak疫毒intrusion, more injuries resulting in blood and viscera of virtual failure, blood and body fluid亏耗, which eventually led to the decline of five internal organs. Dirty air does not emphasize that within the nuclear生痰blood疫毒intrusion, viscera blood deficiency, dysfunctional, often leads to cohesion phlegm, blood stasis within the stop, resulting in sputum nuclear, scrofula疬, such as leucoderma plot. Finally, the five internal organs very empty, blood and body fluid depletion of yin and yang can not be maintained, it must have died from the yin and yang. 【AIDS infection in the central nervous system caused by the tune taken care】 1. First of all, to learn basic knowledge on AIDS, AIDS is an infectious disease, mainly through sexual contact, blood transfusion, blood products and mother to child transmission. AIDS should be aware of the main clinical manifestations and course of action. 2. Mental patients do work, in remission period patients should be allowed to participate in an appropriate social work, so that patients with a good mood to work and treatment. 3. Women living with the disease should avoid pregnancy, to prevent the placenta to the fetus. 【AIDS infection in the central nervous system caused by the sub-card on the Treatment】 1. Evil righteousness injury (1) Governing Law: Qingre Jiedu Yiqi. (2) Prescription: All Yinqiaosan yuping Feng Powder. (3) components: Honeysuckle 15g, Phillyrin 10g, Banlangen 10g, Campanulaceae 6g, Chuan Fritillaria 10g, Arctii 9g, dandelion 15g, Trichosanthin 9g, wind 6g, atractylodes 9g, ginseng 10g, Health licorice 6g. (4) options side: Baidu scattered. Chaihu 6g, imperatorin 6g, Chuanxiong 5g, Aurantii 5g, Notopterygium 6g, Duhuo 6g, Campanulaceae 5g, ginseng 10g, licorice 4g. (5) addition and subtraction: a combination of hand-foot-heart heat, low-grade fever, dry cough, such as habitat plus 15g, Radix 10g, Zhimu 10g, Scrophularia 9g; if and high fever,神昏to Baihu Decoction combined added. (6) clinical matters: Note warm, guard against influenza. 2. Lung Yun evil heat (1) Governing Law: Qingre Huatan泻肺. (2) Prescription: Xiexin White Powder Ma Shigan Decoction. (3) components: Baicalin 6g, Cortex Mori 9g, Zhimu 6g, Yuxingcao 15g, Gualou 9g, Sichuan Fritillaria 10g, Su 9g, Juhong 6g, gypsum 15g, almond 9g, Tenjiku Huang 6g. (4) options side: clearance gas Huatan Pill. Gualou Ren 9g, Chenpi 6g, Baicalin 6g, almond 8g, Zhishi 9g, Poria 12g, gall Southern Star 9g, Qing Banxia 9g. (5) addition and subtraction: constipation increase Huang 6g, hemp seed 9g;尿痛De plus Lardizabalaceae 9g. (6) clinical matters:忌食spicy food irritation. 3. Thermal subsidence camp blood (1) Governing Law: Qingre Liangxue detoxification. (2) Prescription: Xijiao Dihuang Decoction Qingwen Baidu Yin addition and subtraction. (3) components:水牛角30g, saiga horn 10g,生地黄20g, Chishao 15g, paeonol 9g, Danshen 12g, gardenia 9g, Phillyrin 9g, honeysuckle 12g, Scrophularia 9g, Baicalin 6g , Shikonin 10g, acrous gramineus 6g, gypsum 15g. (4) options side: Qingying Decoction.水牛角30g,生地黄15g, Scrophularia 9g, bamboo heart 3g, Radix 9g, Danshen 6g, Huanglian 5g, honeysuckle 9g, Phillyrin 6g. (5) addition and subtraction: If神昏, convulsions, convulsions, etc., may choose to use proprietary Chinese medicine "Sambo" to take. (6) clinical matters: hyperthermia in line with the traditional Chinese medicine to lower the temperature outside the wash. 4. Weak spleen and stomach (1) Governing Law: Jianpi Buxue Yangwei. (2) Prescription: Decoction Liujunzi. (3) components: Astragalus 15g, dangshen 15g, atractylodes 12g, Chinese yam 10g, Poria 12g, cyrtonema 10g, Chaihu 6g, Chenpi 6g, villosum 3g, Angelica 9g, licorice 5g. (4) options side: Buzhongyiqitang. Astragalus 15g, licorice 5g, ginseng 10g, Chinese angelica 10g, orange peel 6g, acteoside 3g, Bupleurum 3g, atractylodes 10g. (5) addition and subtraction: If palpitations jointly Guipi Decoction, such as more than久泻, abdominal pain De plus Aconite system. (6) clinical matters: The patient should pay attention to rest, eating nutritious and appropriate light. 5. Inadequate essence (1) Governing Law: Lean Zishen fill overcast. (2) Prescription: Liuweidihuangwan Hop Ho Zaizao pill addition and subtraction. (3) components: bidentata 9g,紫河车10g,熟地黄10g, aspartic lOg, Michael L lOg, Ejiao 10g, Tortoise 15g, Biejia 10g, paeony 9g, schisandrin 6g, Cistanche 10g, Hyun Participation 9g, cornus officinalis 9g, paeonol 6g. (4) options side: Zuoguiyin.熟地黄30g, Chinese yam 6g, medlar 6g, Zhigancao 3g, pachyman 6g, dogwood 5g. (5) addition and subtraction: If low-grade fever, dry cough, pharyngodynia, the increase of goods Yangyin Moistening Lung; such as cold-shaped肢冷, urination frequency, plus Aconite 6g, cinnamon 8g, Morinda officinalis 12g. (6) clinical matters: spicy忌食objects. 6. Liver kidney-yin deficiency (1) Governing Law: Liver and Kidney Yin. (2) Prescription: Liuweidihuangwan All Erzhi Pill addition and subtraction. (3) components:熟地黄20g, cornus officinalis 12g, Chinese yam 10g, Alisma 6g, paeonol 6g, Radix 9g, Biejia 10g, medlar 10g, Suanzaoren 10g, chrysanthemum 6g, Zhimu 9g, Chinese angelica 9g, Eclipta grass 9g, Ligustrum lucidum 9g. (4) options side: All big yin Yiguanjian pill addition and subtraction. North Adenophora 10g, Radix 10g, Chinese angelica 10g,生地黄30g, medlar 12g,川楝子5g, Huangbai 6g, Zhimu 6g, shells 18g. (5) addition and subtraction: Vertigo For octocarinatus Hopewell Township liver Xifeng Decoction. (6) clinical matters:忌食irritant spicy food, attention daily. 7. Yin Deficiency (1) Governing Law: Yiqi Yangyin. (2) Prescription: astragaloside ShengmaiYin addition and subtraction. (3) components: Astragalus 30g, dangshen 15g, Radix 10g, schisandrin 9g, Zhimu 9g, speculation paeony 9g, Cortex 9g, Ligustrum lucidum 10g. (4) options side: Zhigancao Decoction. Zhigancao 12g, Ginseng 6g, dry Dihuang 30g, Guizhi 10g, Ejiao 6g, Michael L 10g, Cannabis 20g, ginger 10g, jujube 10. (5) addition and subtraction: cough, shortness of breath, lung qi deficiency, such as the evil pit of losses, will be jointly Bufei Decoction. (6) clinical issues: the prevention of influenza, more than drinking water. 8. Blood痰凝 (1) Governing Law: expectorant extinction Huayu scrofula. (2) Prescription: Taohong Siwu Decoction. (3) consists of: peach kernel 10g, safflower 10g, Chishao 9g, Chuanxiong 6g,水牛角15g, gall Southern Star 9g, Banxia 9g, Hill Sagittaria 9g, dangshen 10g, centipede 2, Campanulaceae 3g, Seeds of Brassica alba 6g,竹茹3g. (4) options side: Consumers scrofula tubeimoside Pills Gualou scattered. Scrophulariaceae 10g, oysters 10g, tubeimoside 10g, Gualou 3g, Trichosanthin 2g, pachyman 2g, orange-red 2g, Campanulaceae 2g. (5) addition and subtraction: the weak can be combined physical vitality and Ziyin, Yangxue of goods. (6) clinical matters: to maintain a happy mood,忌食肥甘greasy. 【AIDS infection in the central nervous system caused by the differential diagnosis】 1. Corticosteroids, chemotherapy, radiotherapy or pre-existing malignant tumor and serious protein-energy malnutrition caused by secondary immunodeficiency disease. 2. Primary immunodeficiency disease. 3. Blood disease as a result of AIDS patients have fever, hepatosplenomegaly, lymphadenopathy, inpidual interleukin low lymphocyte reduction. Therefore, the clinical attention should be carried out to identify blood disease. 4. Should pay attention to the central nervous system diseases and other causes of central nervous system disease identification. 5. Infectious mononucleosis AIDS high-risk groups emerged infectious mononucleosis when HIV antibody test that is done.
