AIDS合并播散性非结核分枝杆菌病的临床特征与死亡危险因素分析  

Clinical characteristics and death risk factors of disseminated non-tuberculous mycobacterial infection in AIDS patients

作　　者：吴跃[1] 邓西子 胡凤玉[1] 陈万山[1] 陈谐捷[1] 蔡卫平[1] 唐小平[1] 李凌华[1] 

机构地区：[1]广州市第八人民医院,广东510060

出　　处：《中国艾滋病性病》2017年第11期999-1001,1005,共4页Chinese Journal of Aids & STD

基　　金：广州市医药卫生科技项目(20151A011033);国家自然青年基金(81301480);广东省省级科技计划项目(2014A020212425)~~

摘　　要：目的了解艾滋病(AIDS)合并播散性非结核分枝杆菌病(DNTM)的临床、病原学特点及治疗转归,提高该病诊疗水平。方法回顾性分析30例血培养确定AIDS合并DNTM患者的临床资料,比较存活与死亡患者的差异。结果 30例患者男性26例,女性4例,平均年龄(35.5±7.8)岁。主要临床表现:发热(28例)、咳嗽(23例)、咳痰(17例)、午后发热(16例)等。CD4+T淋巴细胞中位数5个/μL(0~63个/μL)、血沉升高25例、贫血26例、白细胞降低12例、白细胞升高5例、血小板减少7例。30例患者均出现不同程度胸腹部CT影像学异常,主要包括:肝肿大(21例)、脾肿大(24例)、胸腔淋巴结肿大(22例)、腹腔淋巴结肿大(23例)、双肺斑片影(17例)等。30株非结核分枝杆菌(NTM)中,鸟分枝杆菌复合群(MAC)17株,堪萨斯分枝杆菌5株,其他8株。药敏试验显示,对多种抗结核药不同程度耐药,多耐药率86.7%,耐多药率70.0%,广泛耐药率43.3%。25例患者接受正规抗NTM治疗及高效联合抗病毒治疗(HAART),共治愈22例,死亡8例。死亡患者NTM广泛耐药率显著高于存活患者(P<0.05),且接受规范NTM治疗及HAART比例均明显低于后者(P<0.05)。结论 AIDS合并DNTM病原以MAC多见,耐药情况严重,广泛耐药可能与患者死亡相关,接受正规抗NTM治疗及HAART仍效果显著。Objective To explore the clinical characteristics, pathogenic characteristics, treatment outcomes of disseminated non-tuberculous mycobacterial disease（DNTM） in AIDS patients, so as to improve the diagnosis and treatment of the disease. Methods The medical records of 30 AIDS patients with DNTM diagnosed by blood culture were retrospectively studied and comparison was made between the survival group and the dead group. Results Among 30 patients studied, 26 were males and 4 females, with the average age of 35.5±7.8 years old. The major clinical manifestations included fever（28 cases）, cough（23 cases）, expectoration（17 cases）, and afternoon fever（16 cases）. The median CD4＋ count was 5 cells/ul（ranging from 0 to 63 cells/ul）. 25 had elevated erythrocyte sedimentation rate（ESR）, 26 had anemia, 12 had leukopenia, 5 had leukocytosis, and 7 had thrombocytopenia. All 30 patients showed abnormal imaging manifestations in thoracoabdominal CT scans to some extent, mainly including hepatomegaly（21 cases）, splenomegaly（24 cases）, thoracic lymphadenectasis（22 cases）, abdominal lymphadenectasis（23 cases） and patchy shadows in both lungs（17 cases）. 30 NTM strains consisted of 17 mycobacterium avium complex（MAC） ones, 5 M.kansasii ones, and 8 ones identified as other species of NTM. The drug susceptibility testing indicated that 30 NTM strains were resistant to multiple anti-tubercular agents to different extent, of which 86.7% were strains with poly-resistance, 70.0% with multidrug resistance（MDR） and 43.3% with extensive drug resistance（XDR）. 25 patients received standard anti-NTM treatment and highly active antiretroviral therapy（HAART）. In total, 22（73.3%） patients recovered and 8（26.7%） died. The death group possessed significantly higher XDR-TB rate（P=0.049） and lower ration of receiving standard anti-NTM treatment（P=0.003） and HAART（P=0.011） than the survival group. Conclusion The majority of pathogens the AIDS patients have with DNTM bel

关 键 词：艾滋病 播散性非结核分枝杆菌病 临床特点 耐药 治疗转归 

分 类 号：R512.91[医药卫生—内科学]