血液结核分枝杆菌液体培养在HIV感染者结核筛查中的应用评价  

Evaluation of blood liquid culture on screening active tuberculosis among patients with HIV infection

作　　者：张峣[1] 于兰[1] 唐志荣[2] 刘伟[2] 黄绍标 周平 蒙志好 王黎明[6] 赵燕[1] 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]广西疾病预防控制中心 [3]广西南宁第四人民医院艾滋病科 [4]广西柳州疾病预防控制中心 [5]广西龙潭医院艾滋病科 [6]美国疾病预防控制中心GAP项目办公室 [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4期23-27,共5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：目的评价血液结核分枝杆菌液体培养对HIV感染者活动性结核病的诊断价值。方法 2006年8月至2008年7月,对广西省4个诊疗机构中HIV感染者进行包括临床、胸片、痰涂片、痰快速结核分枝杆菌培养和血液快速结核分枝杆菌培养在内的综合筛查以诊断活动性结核。分析结核分枝杆菌血培养在HIV感染者中的总体阳性率和在不同CD4水平患者中的阳性率,总结血培养阳性的结核病患者的临床特点,探讨血培养对结核的诊断价值。结果 602例HIV感染者在结核筛查时进行了血液结核分枝杆菌培养,7例检出结核分枝杆菌菌血症,血结核分枝杆菌培养在HIV感染者中的总体阳性率为1.2%。在CD4计数<200/μl、<100/μl和<50/μl患者组中,血培养阳性率分别为1.4%、1.8%和2.4%,逐渐增高。共诊断活动性结核133例,其中结核分枝杆菌菌血症的阳性率为5.3%。血培养阳性的结核患者中位CD4仅为17/μl,均有明确的肺部影像学改变,2例有粟粒样表现,6例同时行痰结核分枝杆菌培养,其中5例(83%)阳性,5例患者伴有明确的肺外结核。与无结核分枝杆菌菌血症的结核/HIV合并感染者相比,有结核分枝杆菌菌血症的患者BMI和CD4计数较低,盗汗症状更常见。结论血液快速结核分枝杆菌培养在广西HIV感染者中的阳性率总体较低,但随着患者免疫缺陷的加重,阳性率逐渐增高。本研究中有结核分枝杆菌菌血症的HIV感染者均有明显肺部病变,且痰培养的阳性率高,提示结核分枝杆菌血培养对提高HIV感染者中结核的诊断率作用可能有限。Objective To investigate the value of blood liquid culture for tuberculosis（TB） screening and diagnosis among HIV infected persons.Methods From August 2006 to July 2008,patients who attended four HIV clinics in Guangxi were screened for tuberculosis through a TB symptom questionnaire,chest radiography,sputum smear and liquid culture of sputum and blood.The prevalence of TB blood culture among all patients tested and patients of different CD4 strata were calculated.The clinical characteristics of patients with positive blood culture were summarized and compared with patients with negative blood culture.Results Total of 602 patients had blood tuberculosis culture during TB screening.Mycobacterium tuberculosis bacteremia was detected in 7 cases,with an overall positive rate of 1.2%.In patients with CD4 count 200/μl, 100/μl and 50/μl,the positive rates of blood culture rate was 1.4%,1.8% and 2.4%,respectively,increasing as patients＇ immune functions declining.Total of 133 patients were diagnosed as active TB,with 5.3% occurred positive blood culture.For patients with positive blood culture,the median CD4 was 17/μl（8-32/μl）,all with pulmonary involvement indicated by CXR,while only 2 had milliary pattern,5 with extrapulmonary involvement.Six patients with positive blood culture had sputum culture on screening,5 of which were positive（83%）.Compared with negative blood cultrue,patients with TB bacteremia had lower body mass index,lower peripheral blood CD4 count,higher rate of night sweats.Conclusions The overall positive rate of rapid TB blood culture among HIV infected patients in Guangxi was low,while increasing as patients＇ immunodeficiency getting worse.However,our study suggested that adding blood culture leads limited improvement in TB diagnosis among HIV infected patients.

关 键 词：结核病 人类获得性免疫缺陷病毒 诊断试验 结核分枝杆菌培养 

分 类 号：R52[医药卫生—内科学] R512.91[医药卫生—临床医学]