探讨人类免疫缺陷病毒（HIV）感染合并周围性面瘫的临床特点。

回顾性分析首都医科大学附属北京地坛医院2017年1月至2019年12月收治的4例HIV感染合并周围性面瘫患者的临床资料并进行相关文献复习。

4例患者均为男性，年龄28~49岁。病例1存在吸毒、病例2存在男性同性性行为、病例3存在高危性行为等HIV感染高危因素，HIV抗体初筛阳性，蛋白印迹确诊实验均为阳性；病例1和病例4 CD4⁺ T< 200 cells/μl，处于艾滋病期；4例患者发病前均未进行高效抗逆转录病毒疗法（HAART）治疗。4例患者均为单侧周围性面瘫，其中2例为单纯左侧周围性面瘫，1例为右侧周围性面瘫伴眩晕、耳部疼痛，耳周疱疹，1例为左侧周围性面瘫伴双耳听力下降。3例患者合并梅毒螺旋体感染，4例均合并血Epstein-Barr病毒（EBV）感染。病例2存在化脓性中耳炎、耳带状疱疹，病例3骨髓穿刺提示急性淋巴细胞白血病，病例4骨髓穿刺提示为淋巴瘤白血病。治疗：病例1给予维生素B1和腺苷钴胺治疗；病例2给予腺苷钴胺营养神经、阿昔洛韦抗病毒治疗；病例3入院后癫痫持续，给予地西泮镇静及甘露醇脱水治疗；病例4给予甲钴胺、维生素B1营养神经，利妥昔单抗治疗淋巴瘤白血病，拉米夫定、依非韦伦进行HAART治疗。预后：病例1和病例2面瘫改善，病例3和病例4患者死亡。

对于存在高危行为的周围性面瘫患者，应加强HIV感染筛查，进行早期诊断和及时治疗。

To investigate the clinical characteristics of peripheral facial paralysis in patients with human immunodeficiency virus (HIV) infection.

The clinical data of HIV-infected patients with a diagnosis of peripheral facial palsy attending to Beijing Ditan Hospital, Capital Medical University from January 2017 to December 2019 were collected, and related literature were reviewed.

Total of four male patients were enrolled, aged from 28 to 49 years old, most of them had high risk factors of HIV infection, such as drug abuse, male homosexual behavior and high-risk sexual behavior. HIV antibody in screening test and western blot were all positive. CD4⁺ T cells of case 1 and case 4 were both < 200 cells/μl. None of them received highly active antiretroviral therapy (HAART) before. All the cases were unilateral peripheral facial paralysis. Two cases were left peripheral facial paralysis alone. One case was right peripheral facial paralysis with vertigo, ear pain, herpes around the ear. And one case was left peripheral facial paralysis with hearing loss of both ears. Syphilis infection was found in three patients and Epstein-Barr virus infection was found in four patients. Case two had otitis media suppurativa and otitis externa herpetica; case three had acute lymphoblastic leukemia and case four had lymphoma leukemia both suggested by bone bymarrow puncture. Case one was treated with some neurotrophic drugs (VitB1 and Cobamamide). Neurotrophic drugs such as Cobamamide and acyclovir were the mainstay treatment for case two. Because of status epilepticus, case three was given diazepam and mannitol. Case four was treated by HAART with lamivudine, efavirenz. He also received neurotrophic drugs and rituximab. Case one and case two had a good recovery, case three and case four died.

For patients with peripheral facial paralysis had high-risk behaviors, clinicians should consider HIV infection, early diagnosis and treatment are very important.