常见传染病口腔表征及其辨析策略

doi:10.3724/zdxbyxb-2021-0105

浙江大学学报（医学版）

2021, Vol. 50

Issue (2): 141-147 DOI: 10.3724/zdxbyxb-2021-0105

专题报道

常见传染病口腔表征及其辨析策略

陈谦明¹(

),李再晔²,曾昕^2,*(

)

1.浙江大学医学院附属口腔医院浙江大学口腔医学院浙江省口腔疾病临床医学研究中心浙江省口腔生物医学重点实验室浙江大学癌症研究院，浙江杭州 310006
2.四川大学华西口腔医院口腔黏膜病科口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心，四川成都 610041

Diagnostic strategies for oral manifestations of infectious diseases

CHEN Qianming¹(

),LI Zaiye²,ZENG Xin^2,*(

)

1. Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province， Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, China;
2. Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu 610041, China

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摘要：

传染病是指病原微生物感染人体后产生的有传染性并在一定条件下可造成流行的疾病，许多法定传染病如梅毒、白喉、麻疹、获得性免疫缺陷综合征等在口腔内都有特异性和非特异性表征。但在临床实践过程中，同样的疾病在不同患者口腔内表现也有所不同，可运用“三错一变”的策略大致剖析病情。所谓“三错”指临床表现错龄、错位、错效，“一变”指临床表现罕见变常见。本文将对目前常见传染病的口腔表征及其辨析策略进行介绍。

关键词： 传染病; 口腔疾病; 口腔表征; 诊断; 鉴别诊断

Abstract:

Infectious diseases are caused by infection of organism with pathogenic agents, which may lead to epidemics. Many infectious diseases such as syphilis, diphtheria, measles, and acquired immunodeficiency syndrome have specific and non-specific manifestations in the oral cavity. However, the same disease may have different oral manifestations in different patients clinically. We can apply the strategy of “three unusuals and one change” in clinical reasoning for diagnosis of infectious diseases with oral manifestations. The so-called “three unusuals” refer to unusual age, unusual location and unusual effect, and “one change” means the change from rare to common. In this article, we will give a comprehensive introduction about the oral manifestations of common communicable diseases and their diagnostic strategies.

Key words: Infectious diseases Oral diseases Oral manifestations Diagnosis Differential diagnosis

收稿日期: 2021-01-25 出版日期: 2021-06-18

CLC:

R781.5

基金资助: 国家自然科学基金（81621062，81520108009，81972551）

通讯作者: 曾昕 E-mail: qmchen@zju.edu.cn;zengxin22@163.com

作者简介: 陈谦明，教授，主任医师，博士生导师，主要从事口腔黏膜病的病因及防治研究；E-mail：qmchen@zju.edu.cn；https：//orcid.org/0000-0002-5371-4432

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引用本文:

陈谦明,李再晔,曾昕. 常见传染病口腔表征及其辨析策略[J]. 浙江大学学报（医学版）, 2021, 50(2): 141-147.

CHEN Qianming,LI Zaiye,ZENG Xin. Diagnostic strategies for oral manifestations of infectious diseases. J Zhejiang Univ (Med Sci), 2021, 50(2): 141-147.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0105 或 http://www.zjujournals.com/med/CN/Y2021/V50/I2/141

表 1 常见传染病的口腔表征

图 1 获得性免疫缺陷综合征患者的“雪口病”表现患者男性，46 岁，以“口腔内白色无痛性斑块 3 个月”为主诉，否认长期服药史，既往体健.口腔检查见腭部充血红肿，黏膜上有大量白色点状或斑块状白色假膜，用力可拭去，人获得性免疫缺陷病毒抗体检查阳性，确诊为获得性免疫缺陷综合征.

图 2 一期梅毒患者的唇部硬下疳患者男性，38 岁，以“上唇溃烂 1 个月”为主诉，口腔检查见上唇内侧黏膜有 1 处圆形溃疡，边缘微隆，表面少许血痂，周缘界清，质地较韧，行梅毒血清学检查后确诊为一期梅毒硬下疳.

图 3 结核病患者的口腔结核性溃疡患者男性，36 岁，以“左侧咽部溃疡 1 个月”为主诉，口腔检查见腭舌弓、左翼颌皱襞及其周围出现大面积边缘不规则溃疡，常规局部药物治疗后效果欠佳，对溃疡组织行活检，HE 染色示肉芽肿性炎症，抗酸染色发现分枝杆菌，结核分枝杆菌定量 PCR 检测阳性，确诊为结核性溃疡.

图 4 AIDS 患者口腔中 HIV 相关卡波西肉瘤患者女性，39 岁，以“牙龈肿胀 4 个月”为主诉，口腔检查见全口牙龈和腭黏膜增生呈广泛紫红色结节样肿物，HIV 抗体检测阳性，确诊为 AIDS.AIDS：获得性免疫缺陷综合征；HIV：人获得性免疫缺陷病毒.

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