湖北省随州市艾滋病/肺结核病双重感染患者抗结核治疗与抗病毒治疗效果分析  

Therapeutic effect of concurrent anti-tuberculosis and anti-retroviral treatment among TB-HIV co-infected patients

作　　者：殷继国[1] 何卫华[1] 练祖银[1] 许亮[1] 张玉[2] 余晓凤[1] 卢全义[1] 陈丹丹[1] 黄万春[1] 

机构地区：[1]湖北省随州市疾病预防控制中心结防所,湖北随州441300 [2]湖北省疾病预防控制中心结防所

出　　处：《中国预防医学杂志》2015年第3期171-174,共4页Chinese Preventive Medicine

基　　金：第五轮中国全球基金结核病项目(CHN-506-G08-T);湖北省卫生厅科研项目(JX5B49)

摘　　要：目的探讨抗结核药物联合高效抗逆转录病毒药物治疗艾滋病合并肺结核病的近期疗效及不住院治疗管理的可行性。方法对湖北省随州市确诊的艾滋病合并肺结核病患者(AIDS/TB),在给予高效抗逆转录病毒药物治疗的同时,按照《中国结核病防治规划实施工作指南》指定的抗结核药物治疗方案初治痰涂片阳性(涂阳)和初治痰涂片阴性(涂阴)肺结核治疗方案(2HRZE/4HR),复治涂阳肺结核治疗方案(2HRZES/6HRE)给予抗结核药治疗,在治疗期的第2月末、5月末、6月(或8月)末各进行1次痰结核分枝杆菌涂片检查、摄全胸片及临床症状的改善随访调查,治疗前、疗程结束各检查1次CD4+T细胞计数,采用不住院治疗,家庭成员督导为主,村医督导为辅,定期监测随访的治疗管理模式进行管理。结果疗程结束时临床症状改善达96.97%(32/33),胸部病灶显吸及吸收达到100.00%(33/33),空洞消失达到100.00%(4/4),治愈率86.96%(20/23),总治疗成功率88.89%(32/36),CD4+T细胞计数治疗前、后分别为(174.5±139.7)个/μl、(277.9±142.2)个/μl,差异有统计学意义(P<0.01)。结论抗结核药物联合高效抗逆转录病毒药物治疗艾滋病合并肺结核病,近期疗效明显,能有效地提高AIDS/TB患者生存质量并延长寿命;在条件许可的情况下,尽可能同时进行抗结核与抗病毒治疗,以期达到最佳治疗效果及尽可能地降低病死率;采用不住院治疗,家庭成员督导为主,村医督导为辅,定期监测随访的治疗管理模式,在我国广大农村地区开展抗结核药物联合高效抗逆转录病毒药物治疗艾滋病合并结核病患者是切实可行的。Objective To evaluate the therapeutic effect of concurrent anti-tuberculosis and anti-retroviral treatment among TB-HIV co-infected patients,and to assess the feasibility for out-patient treatment. MethodsAnti-tuberculosis therapy was initiated by using two treatment plans of 2HRZE/4HR and 2HRZES/6HRE provided in Implementation Guide of TB control in China among TB-HIV co-infected patients who were being treated with highly active antiretroviral therapy（HAART）for AIDS.Follow-up surveys were conducted and sputum smear examination for bacteria and chest X-ray were performed at the end of two months,five months,six months（or eight months）after the anti-tuberculosis treatment.The CD4＋T cell counts were determined before and after the treatment.All patients were treated at home and monitored mainly by family members.Results By the time the treatment was done,the clinical symptoms of 96.97%（32/33）patients were greatly improved with the chest lesions being partially or completely absorbed.The voids totally disappeared（100%,4/4）.The overall cure rate was 86.95%（20/23）,and the treatment success rate was 88.89%（32/36）.The number of CD4＋T cell increased significantly from 174.5±139.7to 277.9±142.2/ul after treatment（P0.01）. Conclusions The short-term therapeutic effect of anti-tuberculosis treatment for TB-HIV co-infected patients is promising even combined with HAAT treatment for AIDS,which can significantly improve the quality of life and prolong the lives of AIDS/TB patient.Patients can be treated at home and monitored easily by family members,this concurrent treatment is more preferred for patients from rural areas.

关 键 词：艾滋病 结核病 高效抗逆转录病毒 抗结核药物 

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