广西HIV感染者呼吸道非结核分枝杆菌定植情况和临床特点分析  

Nontuberculous mycobacteria colonization in respiratory track of patients with HIV infection in Guangxi

作　　者：张峣[1] 于兰[1] 赵燕[1] 黄绍标 唐志荣[3] 刘伟[3] 蒙志好 周平 王晓犇[6] 张福杰[1,7] 

机构地区：[1]中国疾病预防控制中心性病艾滋病中心治疗与关怀室,北京100050 [2]广西南宁第四人民医院艾滋病科 [3]广西疾病预防控制中心 [4]广西龙潭医院艾滋病科 [5]广西柳州疾病预防控制中心 [6]美国加州大学洛杉矶分校医学院 [7]首都医科大学附属北京地坛医院

出　　处：《中华实验和临床感染病杂志（电子版）》2011年第1期6-9,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家重点基础研究发展计划(973)研究项目(2006CB504201)

摘　　要：目的呼吸道非结核分枝杆菌定植是HIV感染者发生播散性非结核分枝杆菌感染的危险因素,并可能对肺结核的诊断造成干扰。我国HIV感染者中非结核分枝杆菌呼吸道定植情况和临床特点目前尚无较大样本的研究报道。本文分析HIV感染者痰培养中非结核分枝杆菌的阳性率和相关因素,从而总结其临床特点。方法 2006年8月至2008年7月,对广西省4个诊疗机构中CD4<350的HIV感染者进行临床症状、胸片、痰涂片,痰分枝杆菌培养和血液分枝杆菌培养在内的结核筛查。结果 1073例HIV感染者在结核筛查时进行了痰分枝杆菌培养,检出非结核分枝杆菌87例(8.1%),129例(12.0%)为结核分枝杆菌。在痰培养阳性的标本中,43%为非结核分枝杆菌。非结核分枝杆菌在呼吸道的定植率随着患者CD4水平降低而逐渐升高,在CD4计数>200/μl、100～200/μl、50～100/μl和<50/μl的患者组中分别为2.8%、6.4%、7.1%和9.8%。痰涂片抗酸杆菌阳性的患者中12.0%为非结核分枝杆菌,非结核分枝杆菌呼吸道定植的患者中8.5%痰涂片结果为抗酸杆菌阳性。与痰培养阴性的患者相比,有呼吸道非结核分枝杆菌定植的患者CD4水平较低,除体重下降更多见外,其他临床症状如发热、咳嗽、盗汗、乏力等,以及胸片异常表现均未增加。结论我国HIV感染者中痰培养非结核分枝杆菌的阳性率较高,尤其是在CD4<200的患者中,需要加强临床观察。在未有进行细菌培养的情况下,非结核分枝杆菌在呼吸道的定植可能造成结核的误诊,应给予重视。Objective Nontuberculous mycobacteria（NTM）colonization especially mycobacterium avium complex（MAC）,is an independent risk factor for subsequent active NTM infection and dissemination.NTM can be misdiagnosed as tuberculosis due to its positive acid-fast sputum smear.No data currently is available regarding rates of NTM colonization in Chinese patients with HIV/AIDS and these patients＇ demographic and clinical characteristics.This report includes the prevalence of NTM in sputum culture among all patients tested,risk factors for NTM colonization,patients＇ demographic characteristics,and symptoms of NTM colonized patients.Methods From August 2006 to July 2008,patients attended four HIV clinics in Guangxi were screened for tuberculosis and NTM using symptoms-based questionnaire,chest radiography,acid-fast sputum smear,sputum culture and blood culture.ResultsAmong 1073 patients with sputum culture,87（8.1%）were positive for NTM,while 129（12.0%）were positive for mycobacterium tuberculosis.NTM accounted for 43% in positive sputum culture results.In patients with CD4 count 200,100-200/μl,50-100/μl and 50/μl,the rates of positive NTM sputum culture were 2.8%,6.4%,7.1% and 9.8%,respectively,with the rates increased as patients＇ immune functions declined.Among patients with initial positive acid-fast bacillus（AFB）sputum smear,12% turned out to grow NTM on culture 8.5% of NTM colonization confirmed with culture led to a positive AFB sputum smear.Compared with patients without NTM in sputum,NTM colonized patients did not have significantly more clinical symptoms or abnormal chest X-ray findings.Conclusions A sizable proportion of HIV patients in Guangxi had respiratory track NTM colonization,especially patients with CD4 less than 200,who may require close clinical monitoring.Without NTM sputum culture,a considerable number of positive sputum smear results will be misdiagnosed as tuberculosis.

关 键 词：分枝杆菌 非结核 定植 人类获得性免疫缺陷病毒 痰培养 

分 类 号：R512.91[医药卫生—内科学]