结核分枝杆菌培养阳性的艾滋病合并结核病患者的临床特点  

Clinical features of AIDS-tuberculosis co-infection patients with positive Mycobacterium tuberculosis culture

作　　者：黄爱春[1] 卢祥婵[1] 周子钧[1] 何华伟[1] 朱庆东[1] 周曼 卢洪洲[2] HUANG Ai-chun;LU Xiang-chan;ZHOU Zi-jun;HE Hua-wei;ZHU Qing-dong;ZHOU Man;LU Hong-zhou(Department of Tuberculosis,the Forth Hospital of Nanning ＆ Guangxi（Nanning）Clinical Treatment Center of AIDS,Nanning 530023,China;Department of II~ction and Immunization,Shanghai Public Health Clinical Center,Shanghai 201508,China)

机构地区：[1]广西南宁市第四人民医院暨广西艾滋病临床治疗中心(南宁)结核科,广西南宁市530023 [2]上海市公共卫生临床中心感染与免疫科,上海市201508

出　　处：《广西医学》2018年第10期1129-1131,共3页Guangxi Medical Journal

基　　金：国家科技重大专项(2012ZX10001-003;2017ZX10202101);广西南宁市科学研究与技术开发计划(20163116)

摘　　要：目的分析结核分枝杆菌培养阳性的AIDS合并结核病患者的临床特点。方法回顾性分析610例AIDS合并结核病患者的临床资料,分析患者结核分枝杆菌培养阳性及耐药的发生情况,总结结核分枝杆菌培养阳性患者的一般情况、临床表现及治疗后的转归情况。结果结核分枝杆菌培养阳性共97例,阳性率为15.9%,耐药36例,耐药率为37.1%,其中单耐药10例(10.3%),多耐药11例(11.3%),耐多药14例(14.4%),广泛耐药1例(1.0%)。复治患者、初治患者的耐多药率分别为26.1%(6/23)、10.8%(8/74),差异无统计学意义(P>0.05)。结核分枝杆菌培养阳性患者的主要临床表现包括发热、消瘦、咳嗽及咳痰,均合并其他机会性感染;治疗后84例患者(86.6%)症状好转,痰结核分枝杆菌培养阴性,治疗6个月后CD4+T淋巴细胞计数较治疗前升高(P<0.05),13例(13.4%)患者死亡。14例耐多药结核病患者中,3例死亡,11例(78.6%)经耐多药结核方案治疗后,CD4+T淋巴细胞上升,治疗后6个月痰结核分枝杆菌培养均阴性。结论 AIDS合并结核病患者的结核分枝杆菌培养阳性率低,而结核耐药发生率及死亡率均较高,但耐多药者经规范化治疗仍可获得较好的治疗效果。Objective To investigate the clinical features of AIDS-tuberculosis co-infection patients with positive Mycobacterium tuberculosis culture. Methods The clinical data of 610 patients with AIDS-tuberculosis co-infection were retrospectively analyzed. The incidence of positive Mycobacterium tuberculosis culture and drug resistance were assessed. The general condition,clinical manifestations and outcome after treatment were summarized. Results Positive Mycobacterium tuberculosis culture was found in 97 patients,and the positive rate was 15. 9%. Among the 36 cases with drug-resistant tuberculosis（ the drug-resistant rate was 37. 1%）,mono-resistance was found in10 cases（ 10. 3%）,multiple drug resistance in 11 cases（ 11. 3%）,multiple drug-resistant tuberculosis in 14 cases（ 14. 4%）,and extensively drug-resistant tuberculosis in 1 cases（ 1. 0%）. The multiple drug resistance rates of the recurrence patients and initial patients were 26. 1%（ 6/23） and 10. 8%（ 8/74） respectively,but no statistically significant difference was observed（ P〉0. 05）. The main clinical manifestations of patients with positive Mycobacterium tuberculosis culture included fever,marasmus,cough and expectoration,and those patients were all complicated with other opportunistic infection. After treatment,84 patients（ 86. 6%） achieved improvement in symptoms,negative Mycobacterium tuberculosis of sputum culture and elevated CD4^＋T lymphocytes counts after 6 months（ P〈0. 05）,and 13 patients（ 13. 4%）died. Among the 14 patients with multiple drug resistance,3 patients died,11 patients（ 78. 6%） received anti multiple drug-resistant tuberculosis therapy,then achieved elevated CD4^＋T lymphocytes counts and negative Mycobacterium tuberculosis rate of sputum culture after 6 months. Conclusion In the patients with AIDS-tuberculosis co-infection,the positive rate of Mycobacterium tuberculosis is low,but the drug resistance rate and mortality are quite high. The patients with multiple drug resistance can obtai

关 键 词：艾滋病 结核病 结核分枝杆菌 耐药 

分 类 号：R512.91[医药卫生—内科学]