结核并HIV感染病人发现与临床分析  

CLINICAL ANALYSIS AND CASE-FINDING OF TB/HIV CO-INFECTION IN HENAN

作　　者：甄新安[1] 苏振修[2] 刘占峰[1] 刘国华[1] 雷朝宽 马士文[1] 王国杰[1] 

机构地区：[1]河南省疾病预防控制中心,郑州450016 [2]河南省胸科医院 [3]河南省卫生厅全球基金结核病项目办公室

出　　处：《现代预防医学》2010年第24期4667-4671,共5页Modern Preventive Medicine

基　　金：第五轮全球基金结核病项目(CHN-506-G08-T);世界银行贷款/英国赠款中国结核病控制项目实施性研究项目(CP00D41D8CD98F00B204E9800998ECF8427E.jpg)资金支持

摘　　要：[目的]了解结核并HIV感染病人发现状况与临床特点,为制订TB/HIV双重感染防治工作规划提供依据。[方法]采用整群抽样方法,以第五轮全球基金结核病项目县10个单位调查点,2007年9月1日前进行回顾性调查,以后进行前瞻性调查。[结果]回顾组238例,前瞻组335例。就诊延误率较低(7.2%),诊断延误率较高(74.1%),前瞻组明显较高;发热和纳差等其他症状达45%,咯血为2%,前瞻组无症状率较高(6%);肺外结核比率较低(23%),前瞻组明显高;粟粒型肺结核比率较高(12%);痰涂阳性率21%,前瞻组明显低;PPD阳性率较高(72%),前瞻组涂阴比率明显较高;CD4记数≤200/mm3较低(58.1%);X线中下病变为主者较高(46%)。[结论]结核并HIV病人因症状不典型、诊断依据少使诊断延误率和漏诊率高;第五轮全球基金结核病项目使结核并HIV病人的发现较项目前有明显提高,但肺外结核、涂阴肺结核仍存在严重的误诊、漏诊问题,应进一步加大HIV/AIDS病人结核病筛查的普及范围、加强对双感病人的诊断技术培训。[Objective]To learn the clinical character and case-finding status of TB/HIV co-infection in Henan Province,and to provide scientific evidence for the TB/HIV co-infection control and prevention.[Methods]Ten counties of Global Fund Round 5 TB Project in Henan Province were chosen as study site,retrospective questionnaire survey was used before September 1st 2009,and then prospective questionnaire survey was taken.[Results]Retrospective group had 238 cases and Prospective group had 335 cases.In the both group,the rate of patient delay was low（7.2%）,but the rate of diagnostic delay was high（74.1%,especially the prospective group）.Most of the clinical symptoms in both group were fever and anorexia（45%）,emptysis（2%）,about 6% patients in prospcetive group did not have symptoms.The rate of extrapulmonary TB was 23%,and prospective group was higher.The rate of miliary TB was 12%.The rate of sputum smear positive was 21%,but the prospective group was lower.The rate of PPD positive was 72%.The rate of CD4≤200/mm3 was 58.1%.46% of patients were middle and lower lung TB disease by X-ray result.[Conclusion]Symptoms and diagnostic evidence of TB/HIV co-infectious patients are non-typical,the rate of case-finding of TB/HIV co-infection is higher than that before implementing the Global Fund Round 5 in henan province,but the extrapulmonary TB and smear negative TB still has the problem of misdiagnosis and missed diagnosis.

关 键 词：结核 艾滋病病毒感染 发现延误 

分 类 号：R512.91[医药卫生—内科学]