肺结核合并艾滋病患者抗结核治疗的转归及危险因素分析  

Prognosis and risk factors of anti-tuberculosis treatment of pulmonary tuberculosis in patients with AIDS

作　　者：陈焯彬[1] 梁浩[2] 

机构地区：[1]钦州市第一人民医院感染科,广西钦州535000 [2]广西医科大学公共卫生学院&艾滋病研究中心,南宁530021

出　　处：《中华实用诊断与治疗杂志》2016年第11期1080-1081,共2页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81171624)

摘　　要：目的分析肺结核合并艾滋病患者抗结核治疗的转归，探讨导致不良转归的危险因素。方法对117例接受抗结核治疗的肺结核合并艾滋病患者的转归情况进行调查，分析体质量、年龄、CD4^＋T淋巴细胞计数、抗病毒治疗接受情况、HIV感染时间、HIV感染途径、肺结核类型、其他机会感染等对患者不良转归的影响。结果117例患者死亡21例为不良转归组，96例为未死亡组，病死率17．9％；不良转归组患者开始抗结核治疗时CD4^＋T淋巴细胞计数[（89．7±55．2）个／μL]、实施抗病毒治疗率（52．4％）均低于未死亡组[（173．5±82．4）个／μL、91．7％]，经静脉吸毒感染HIV（66．7％）、涂阳肺结核比率（57．1％）高于未死亡组（39．6％、32．3％）（P〈0．05）；未接受抗病毒治疗（OR=12．391，95％CI：2．552～35．871，P=0．000）、静脉吸毒感染HIV（OR=0．259，950CI：0．105～0．551，P=0．001）、涂阳肺结核（OR=0．412，95％CI：0．182-0．805，P=0．000是不良预后的独立危险因素。结论肺结核合并艾滋病患者抗结核治疗期间病死率高，未接受抗病毒治疗、静脉吸毒感染HIV及涂阳肺结核是其不良预后的危险因素。Objective To observe the outcome of anti-tuberculosis treatment of pulmonary tuberculosis in patients with AIDS and to analyze the risk factors of poor prognosis. Methods A total of 117 patients with AIDS receiving antituberculosis treatment of pulmonary tuberculosis were analyzed their prognosis. The influence of body mass, age, CD4＋ T-lymphocyte level, antiviral therapy, duration of HIV infection, route of HIV infection, type of pulmonary tuberculosis and other opportunistic infections on adverse outcome were observed. Results In 117 patients, 21 died （poor prognosis group） with the fatality rate of 17.9%, and 96 survived patients were as alive group. In poor prognosis group, CD4＋ Tlymphocyte level （（89. 7 ±55. 2）/μL） and the percentage of patients receiving antiviral therapy （52. 4%） were significantly lower, and the infecting rate of H IV via intravenous drug use （66. 7%） and proportion of positive smear pulmonary tuberculosis （57. 1%） were significantly higher than those in alive group （（173. 5 ± 82. 4）/μL, 91. 7%, 39.6%, 32.3%） （P〈0.05）. No antiviral therapy （OR=12. 391, 95 %CI： 2. 552 to 35. 871, P=0. 000）, HIV infected via intravenous drug use （OR= 0. 259, 95 % CI： 0. 105 to 0. 551, P= 0. 001） and positive smear pulmonary tuberculosis （OR=0. 412, 95%CI： 0. 182 to 0. 805, P=0. 000） were independent risk factors for poor prognosis. Conclusion The fatality rate is high in anti-tuberculosis treatment in patients with pulmonary tuberculosis complicated with AIDS. No antiviral therapy, HIV infected via intravenous drug use and smear positive pulmonary tuberculosis are the risk factors for poor prognosis.

关 键 词：肺结核 艾滋病 抗结核治疗 转归 危险因素 

分 类 号：R521[医药卫生—内科学] R512.91[医药卫生—临床医学]