人類嗜T淋巴球病毒引發急性呼吸窘迫症之呼吸照護經驗

Respiratory Care Experience of Taking Care Human T Lymphotropic Virus Induced Acute Respiratory Distress Syndrome Patient

楊玉群(Yu-Chum Yang) ； 陶啟偉(Chi-Wei Tao) ； 曾媖琴(Ying-Chin Tseng)

《呼吸治療》 12卷1期 (2013/01) Pp. 59-70

https://doi.org/10.6269/JRT.2013.12.1.06

摘要

人類嗜T淋巴球病毒（Human T lymphotropic virus 簡稱HTLV）是一種反轉錄病毒，其主要分為HTLV-I和HTLV-II兩型。目前已證實HTLV-I會引起下列2種疾病；人類T細胞性白血病/淋巴癌（簡稱ATL）與一種有關神經方面的疾病-相關性脊髓病熱帶痙攣性截癱；但發病率都很低，至於HTLV-II的致病情形目前仍不清楚。人體感染HTLV後，經血清檢查呈HTLV抗體陽性反應者，稱為HTLV帶原者，其帶原者具傳染力，會經由母乳、血液或體液傳染給他人。而臨床上病患常會出現淋巴腺腫大、肝脾腫大、皮膚病灶如紅斑、骨骼溶蝕性病灶、及高血鈣症等症狀。此外，病患罹病後對感染的抵抗力會降低，因此容易得到伺機性病原菌之感染。但此病預後甚差，無論以何種化療組合其緩解期均十分短暫，且大部分病人於診斷確立後十二個月內死亡，平均存活期不到一年。本個案為日籍商人，最後檢驗出HTLV抗體呈陽性，因急性呼吸窘迫所導致的嚴重低血氧無法改善而改採用氣道壓力釋放通氣（Airway pressure-release ventilation,APRV），雖然病程進展快速最終仍不幸死亡，但此疾病極為罕見故以此與大家分享討論。

關鍵字

人類嗜T淋巴球病毒（Human T lymphotropic virus,HTLV） ； 急性呼吸窘迫症候群（Acute respiratory distress syndrome,ARDS） ； 氣道壓力釋放通氣（Airway pressure-release ventilation, APRV）

並列摘要

The Human T-lymphotropic virus (HTLV) is a retrovirus. A person will become a HTLV carrier if he or she is infected with HTLV and his or her serum tests positive for anti-HTLV antibodies. HTLV carriers are infectious, and they can transmit the virus through breast milk, blood or bodily fluids. Common clinical symptoms of HTLV include lymphadenopathy, hepatosplenomegaly, lytic bone lesions and hypercalcaemia, and skin lesions such as erythema. Additionally, HTLV weakens the immune system, making the patients susceptible to opportunistic infections. The prognosis of an HTLV-infection is usually bad. Regardless of what chemotherapeutic combination is used, the remission period of the virus is very short. Furthermore, the average survival for HTLV patients is less than a year, and most patients will die within twelve months of their diagnosis. In one case study, a Japanese businessman tested positive for anti-HTLV antibodies. Although the patient was treated with airway pressure-release ventilation (APRV) for severe hemic hypoxia, which was caused by acute respiratory distress syndrome (ARDS), the disease spread rapidly and the patient eventually died. HTLV is a very rare disease and so this particular patient case is often used when discussing the virus.

並列關鍵字

human T-lymphotropic virus (HTLV) ； acute respiratory distress ventilation (ARDS) ； airway pressure-release ventilation (APRV)