114例血培养结核分枝杆菌阳性AIDS患者临床分析  

Clinical analysis of 114 AIDS patients with positive blood culture for Mycobacterium tuberculosis

作　　者：李雪琴[1] 刘升[1] 邓建宁[1] 黄爱春[1] 卢祥婵[1] 

机构地区：[1]南宁市第四人民医院(广西艾滋病临床治疗中心(南宁))艾滋病科,530023

出　　处：《传染病信息》2013年第4期224-226,共3页Infectious Disease Information

基　　金：国家"十二五"科技重大专项(2012ZX10001-003);广西科学研究与技术开发计划项目(1298003-1-3)

摘　　要：目的分析血培养结核分枝杆菌阳性AIDS患者的临床资料，为AIDS合并结核病的诊治提供依据。方法回顾性分析114例血培养结核分枝杆菌阳性AIDS患者的临床资料。结果114例中男95例，女19例，从出现临床症状到就诊的中位时间为36d。临床表现主要有发热（102例）、消瘦（97例）、咳嗽（78例）、咳痰（63例）、盗汗（51例）、腹泻（45例）和浅表淋巴结肿大（45例）。CD4＋T淋巴细胞为4～501个／mma，其中〈100个／mm3有105例（92．1％）。结核病耐药41例（36．O％），其中单耐药11例（9．6％），耐多药及广泛耐药14例（12．3％）。腹主动脉旁淋巴结肿大44例（38．6％）。胸腔积液31例（27．2％），心包积液18例（15．8％）。胸片检查异常99例（86．8％）。经治疗后，35例（30．7％）死亡，其中33例（94．3％）CD4^＋T淋巴细胞〈100个／mm^3。结论血培养结核分枝杆菌阳性多见于CD4＋T淋巴细胞〈100个／mm3的男性AIDS患者，病程约1个月，临床表现主要为发热、消瘦、咳嗽、咳痰及淋巴结肿大，可有胸腔积液，大部分患者肺部有病灶。结核病耐药发生率高，晚期患者病死率高。Objective To analyze the clinical data of AIDS patients with positive blood culture for Mycobacterium tuberculo- sis, so as to provide an evidence for the diagnosis and treatment of AIDS complicated by tuberculosis. Methods The clinical data of 114 AIDS patients with positive blood culture for M. tuberculosis were analyzed retrospectively. Results Of 114 AIDS patients, 95 were males, and 19 were females. The median duration from the presence of clinical symptoms to clinic visit was 36 days. The main clinical manifestations were fever in 102 patients, marasmus in 97 patients, cough in 78 patients, expectoration in 63 patients, night sweat in 51 patients, diarrhea in 45 patients and superficial lymph node enlargement in 45 patients. The CD4^＋ T lymphocyte count ranged from 4 cells/mm3 to 501 cells/mm3, and 105 patients （92.1%） had a CD4^＋ T lymphocyte count of less than 100 cells/mm3. Drug-resistant tuberculosis affected 41 patients （36.0%）, of whom 11 （9.6%） suffered from single-drug-resistant tuberculosis, and 14 （12.3%） from muhi-drug-resistant tuberculosis or extensively drug-resistant tuberculosis. Forty-four patients （38.6%） presented with abdominal aorta lymph node enlargement, 31 （27.2%） with pleural effusion, and 18 （15.8%） with pericardial effusion. Chest X- ray abnormalities were found in 99 patients （86.8%）. After treatment, 35 patients （30.7%） were dead, of whom 33 （94.3%） had a CD4~ T lymphocyte count of less than 100 cells/mma. Conclusions Positive blood culture for M. tuberculosis usually occurs in male AIDS patients who have a CD4~ T lymphocyte count of less than 100 cells/mm3. The disease duration is about 1 month. The main clinical manifestations are fever, marasmus, cough, expectoration, lymph node enlargement and pleural effusion. Pulmonary focus occurs in most of the patients. The incidence rate of drug-resistant tuberculosis is high, and the mortality rate in the patients in the late stage is high.

关 键 词：获得性免疫缺陷综合征 细菌 结核 药物耐受性 

分 类 号：R512.91[医药卫生—内科学] R962[医药卫生—临床医学]