HIV/AIDS合并痰抗酸菌涂片阴性肺结核112例临床分析  

Clinical analysis of 112 patients with HIV/AIDS complicated with smear negative pulmonary tuberculosis

作　　者：吴晓瑛 荀运浩 吕铁峰 喻剑华 时代强 

机构地区：[1]杭州市西溪医院,310023

出　　处：《中华实验和临床病毒学杂志》2017年第5期450-453,共4页Chinese Journal of Experimental and Clinical Virology

摘　　要：目的 探讨HIV/AIDS合并涂阴肺结核的临床特征和诊断方法.方法 收集2013年1月-2015年9月住院的112例HIV/AIDS合并痰抗酸菌涂片阴性肺结核患者的有关临床资料.统计其临床症状出现的频率,血常规、血生化、T淋巴细胞亚群检测、痰涂片找抗酸杆菌、痰结核菌培养、PPD试验,血T-SPOT.TB、TB-DNA和胸部CT等检查的结果,分析各指标的诊断特异性和灵敏度.结果 112例患者临床表现,肺部CT表现不典型.血T-SPOT.TB、TB-DNA、PPD灵敏度低.而T-SPOT.TB和PPD检测阳性率在CD4＋细胞计数＞200个/μl亚组明显高于CD4＋细胞计数≤50和51≤CD4≤200个/μl亚组（P＜0.01）.结论 HIV/AIDS合并痰抗酸菌涂片阴性肺结核的诊断复杂,需结合临床表现和辅助检查结果进行综合判断.Objective To investigate the clinical features and reliable diagnostic method in HIV/ AIDS patients with smear negative pulmonary tuberculosis （TB）.Methods Clinical data of 112 HIV/AIDS patients complicated with smear negative pulmonary TB who were treated in our hospital from January 2013 to September 2015 were retrospectively analyzed.These clinical data includeded clinicai symptom,blood routine test,blood biochemistry,T lymphocyte subsets classification,sputum acid-fast bacillus smear,mycobacterium tuberculosis culture,purified protein derivatives tuberculin （PPD） test,interferon gammarelease assay for Mycobacterium tuberculosis （T-SPOT.TB）,TB-DNA and chest computed tomography （CT）.Diagnostic specificity and sensitivity of these parameters were analyzed.Results No specific clinical manifestation of these patients was identified.The chest CT feature was also atypical.The positive rates including T-SPOT,TB,TB-DNA and PPD test were all low.The positive rates of T-SPOT.TB and PPD test in patients with a CD4 ＋ cell count 〉 200 cells/μl was significantly higher than that of patients with a CD4 ＋ cell count ≤ 50 cells/μl and 51 ≤ CD4 ≤ 200 cells/μl （P 〈 0.01）.Conclusions The clinical feature of smear negative pulmonary TB in HIV/AIDS patients is atypical.For a definite diagnosis,a comprehensive analysis with clinical manifestations,laboratory test,imaging examination and etiologic detection is required.

关 键 词：HIV AIDS 肺结核 

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