HIV/AIDS合并非结核分枝杆菌肺病97例临床分析  

Clinical analysis of 97 HIV/AIDS patients with nontuberculous mycobacterial lung disease

作　　者：银春莲[1] 谢周华[1] 裴洁[1] 张洁[1] 欧健[2] 

机构地区：[1]广西南宁市第四人民医院广西艾滋病临床治疗中心(南宁)结核科,530023 [2]广西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》2015年第2期112-114,共3页Infectious Disease Information

基　　金：广西壮族自治区南宁市科学研究与技术开发计划课题(20123143)

摘　　要：目的探讨HIV/AIDS合并非结核分枝杆菌(nontuberculosis mycobacteria,NTM)肺病的临床特点,以提高诊疗水平。方法对我院2009—2012年97例HIV/AIDS合并NTM肺病患者进行回顾性分析。结果 97例中咳嗽93例(95.88%),咳痰88例(90.72%),气喘71例(73.20%),发热70例(72.16%),消瘦69例(71.13%),乏力58例(59.79%),胸痛47例(48.45%),腹泻36例(37.11%)。HIV感染途径为性乱史64例(65.98%),静脉吸毒史26例(26.80%),输血史2例(2.06%),不详5例(5.15%)。胸部影像学表现以双肺中下叶多见,多为左下肺受累,形态多种多样,并容易形成空洞及支气管扩张样改变,可见胸膜病变。结论 HIV/AIDS合并NTM肺病的临床症状、胸部影像学表现、痰涂片、PPD试验和结核抗体检查酷似肺结核,在痰培养结果未回报前,临床上二者鉴别诊断非常困难。患者通常合并多处浅表淋巴结肿大,反复痰涂片抗酸杆菌阳性。痰培养药物敏感性试验提示对一线抗结核药物耐药率高,应引起临床足够重视。Objective To investigate clinical features of HIV/AIDS patients with nontuberculous mycobacterial lung disease, so as to improve the diagnosis and treatment of HIV/AIDS combined with nontuberculous mycobacterial lung disease. Methods A retrospective study was made on 97 HIV/AIDS patients with nontuberculous mycobacterial lung disease treated in our hospital from 2009 to 2012. Results Of 97 patients, 93 （95.88%） had cough, 88 （90.72%） had sputum, 71 （73.20%） had asthma, 70 （72.16%） had fever, 69 （71.13%） had weight loss, 58 （59.79%） had fatigue, 47 （48.45%） had chest pain, and 36 （37.11%） had diarrhea. Sixty-four patients （65.98%） were infected with HIV through sexual transmission, 26 （26.80%） through intravenous drug use, 2 （2.06%） through blood transfusion, and 5 （5.15%） through unknown routes. Chest imaging showed that bilateral middle and lower lung lobes were com- monly affected, mainly in lower left lung, with diversified morphology, cavity formation and presence of bronchiectasis and pleural disease. Conclusions Because the clinical and radiologic features, and the results of sputum smear, PPD testing and tuberculosis antibody test of nontuberculous mycobacterial lung disease mimic tuberculosis, discrimination of nontuberculous mycobacterial lung disease from tuberculosis is difficuh. The patients often present with superficial lymph node enlargement and sputum smear positive for acid-fast bacilli. Sputum culture/susceptibility testing suggests that the resistance to first-line anti-tuberculosis drugs is high, which should be paid due attention to in clinical practice.

关 键 词：获得性免疫缺陷综合征 HIV 非结核性分枝杆菌 

分 类 号：R512.91[医药卫生—内科学] R373.51[医药卫生—临床医学]