获得性免疫缺陷综合征并发结核病35例临床并预后分析  

Clinical and Prognostic Analysis of 35 Patients of Acquired Immunodeficiency Syndrome Complicated With Tuberculosis

作　　者：孔伟利[1] 白大鹏[1] 

机构地区：[1]天津市海河医院结核科,天津300350

出　　处：《继续医学教育》2017年第12期107-109,共3页Continuing Medical Education

基　　金：天津市卫生计生委科技基金项目(2015KZ045)

摘　　要：目的分析结核菌/艾滋病病毒双重感染患者的临床特点、影像学及化验检查、随诊预后等,探讨艾滋病并发结核的发生与CD4^+T淋巴细胞计数的相关性,提高对该病的诊疗水平,改善此类患者的预后。方法回顾性分析35例结核菌/艾滋病病毒双重感染患者的病例资料,对性别、年龄构成、临床分型、临床表现、影像资料、化验室检查、CD4^+T淋巴细胞计数、与抗病毒治疗关系、随诊及预后等相关信息进行汇总分析。结果本研究共收集35例结核菌/艾滋病病毒双重感染患者,男∶女为16.5∶1,平均年龄(43.57±14.34)岁,主要为艾滋病并发继发性肺结核,其次为肺结核合并结核性胸膜炎、单纯淋巴结结核、肺结核合并淋巴结核,肺外结核共10例,占28.6%;临床表现以发热伴咳嗽、咳痰、乏力、纳差、体质量下降多见;当CD^4+T淋巴细胞数目少于100/mm^3时,病变累及肺野以及合并空洞、淋巴结肿大等概率升高,但无统计学意义;血沉、结核抗体、结核菌素试验(PPD)、结核感染T细胞检测(T-SPOT)等阳性率均偏低;确诊时未进行抗病毒治疗30例,占85.7%;随访35例患者治愈16例,1年内复发3例,死亡1例。结论 HIV与结核病的发生紧密相关,二者互相促进。免疫抑制的程度是混合感染者最主要的预测因素,CD4^+T淋巴细胞水平的下降也与增加的结核死亡率相关,且TB/HIV患者临床症状复杂,影像表现多样,诊断和治疗均存在较大困难。Objective To investigate the clinical characters, imaging and laboratory tests, prognosis of TB/HIV patients, to probes into the correlation of CD4＋T lymphocyte count with TB/HIV, to improve the level of diagnosis and treatment of the disease. Methods 35 patients with TB/HIV were enrolled in the study and analyzed retrospectively, including gender, age composition, clinical classifcation, clinical manifestation, image data, laboratory inspection, the count of CD4＋T lymphocyte, the relationship with antiviral therapy, follow-up diagnosis and prognosis. Results 35 patients with TB/HIV were enrolled into the study, the ratio of male to female was 16.5：1 and the mean age was （43.57±14.34）years old. The main clinical classification was secondary pulmonary tuberculosis, followed by 10 cases of TB combined with tuberculous pleuritis, simple tuberculosis of lymph nodes, TB combined with scrofula, extra pulmonary tuberculosis, accounting for 28.6%. The clinical manifestations in 35 TB/HIV patients were fever with cough, sputum, fatigue, poor appetite, loss of weight. When the number of CD4＋T lymphocytes was less than 100/mm3, the probability of lesions range with lung, cavity and lymph node enlargement was increased, but there was no statistical significance. The rates of blood sedimentation, tuberculosis antibody, PPD, and T-SPOT were low. Thirty cases were not treated with antiviral treatment at the time of diagnosis, accounting for 85.7%. During the follow-up study, 16 cases were cured, 5 cases were recurrence, 1 case died. Conclusion HIV is closely related to the incidence of tuberculosis, and the degree of immunosuppressant is an important predictor. The decline of CD4＋T lymphocyte levels are also associated with increased TB mortality, and the clinical symptoms of TB/HIV are complex, the images are diverse, thus increasing the diffculty of diagnosis and treatment.

关 键 词：人类免疫缺陷病毒/艾滋病 结核病 CD4+T淋巴细胞 

分 类 号：R512.91[医药卫生—内科学]