艾滋病合并非结核分枝杆菌病患者的临床特点及预后分析  

Clinical characteristics and prognosis ofAIDS patients with nontuberculous mycobacterial disease

作　　者：蒙志好 左勇 邬剑威 沈银忠[2] MENG Zhi-hao;ZUO Yong;WU Jian-wei;SHEN Yin-zhong(Department of Infectious Diseases,Longtan Hospital of Guangxi Zhuang Autonomous Region,Liuzhou545005,China)

机构地区：[1]广西壮族自治区龙潭医院感染性疾病科,柳州545005 [2]上海市公共卫生临床中心感染与免疫科,201508

出　　处：《传染病信息》2018年第6期544-547,共4页Infectious Disease Information

基　　金：国家科技重大专项(2017ZX10202101;2012ZX1001003)

摘　　要：目的探讨艾滋病合并非结核分枝杆菌病患者的临床特点及预后。方法选取2012年11月—2015年3月广西壮族自治区龙潭医院收治的符合选例标准的艾滋病合并非结核分枝杆菌病患者29例作为研究对象,分析其临床表现、抗非结核分枝杆菌治疗和抗反转录病毒治疗的效果及转归。结果 29例患者中,非结核分枝杆菌肺病确诊和临床诊断病例各13例(各占44.8%)、肠炎2例、淋巴结炎1例。同时伴有2个部位以上病变者10例(34.5%)。临床症状以乏力(28/29,96.6%)、纳差(27/29,93.1%)、发热(24/29,82.8%)为主要表现,发热多为高热,其他常见的临床表现包括咳嗽(19/29,65.5%)、体质量减轻(23/29,79.3%)和淋巴结肿大(16/29,55.2%)。基线CD4+T淋巴细胞中位数23个/μl,伴有轻、中度贫血者9例(31.0%),痰涂片抗酸杆菌阳性4例(13.8%)、痰培养抗酸杆菌阳性21例(72.4%),其他标本培养抗酸杆菌阳性8例(27.6%),经鉴定均为非结核分枝杆菌。胸片提示肺内有病灶、心包或胸腔积液、纵隔淋巴结肿大25例(86.2%)。经抗非结核分枝杆菌及抗病毒治疗,23例(79.3%)有效,死亡4例,自动退出2例。23例有效病例72周时痰及其他标本培养均为阴性,肿大的浅表及腹腔淋巴结全部缩小或消失,其中21例患者胸片提示肺部病灶完全吸收,2例肺部病灶大部分吸收,免疫功能均得到重建。结论艾滋病合并非结核分枝杆菌病多发生于免疫力低下患者,以肺部受累多见,常累及多个部位,临床上主要表现为乏力、纳差、发热、咳嗽、体质量减轻和淋巴结肿大,规范治疗后预后良好。Objective To explore the clinical characteristics and prognosis of AIDS patients with nontuberculous mycobacterial disease(NTMD).Methods Twenty-nine AIDS patients with NTMD who met the inclusion criteria of the National“Twelfth Five-Year Plan”Science and Technology Major Project were enrolled from Longtan Hospital of Guangxi Zhuang Autonomous Region from November 2012 to March2015.Clinical manifestations,anti-NTMD treatment,anti-retroviral treatment and outcomes of 29 patients were analyzed.Results Among the 29 patients,13 cases(44.8%)had confirmed pulmonary NTMD,13cases(44.8%)had probable pulmonary NTMD,2 cases had enteritis and1case had lymphadenitis.Ten cases(34.5%)were involved in more than 2 organs.The main clinical presentations included fatigue(28/29,96.6%),anorexia(27/29,93.1%),fever(24/29,82.8%),most patients had high fever and showed cough(19/29,65.5%),weight loss(23/29,79.3%)and lymphadenopathy(16/29,55.2%).The median of baseline CD4+T lymphocytes was23/μl,9 cases(31%)had mild to modest anemia,4 cases(13.8%)were positive for sputum acid bacilli smear,21cases(72.4%)were positive for sputum culture of acid-fast bacillus,8cases(27.6%)positive for other specimens of acid-fast bacillus,which were identified as nontuberculous mycobacterium.Twenty-five cases(86.2%)had lesions in the lung,pericardial or pleural effusion,mediastinal lymphadenopathy on chest radiography.After ant-NTMD and antiviral treatment,23cases(79.3%)achieved good treatment response,4cases died and2cases were withdrawn automatically.The sputum and other specimens were negative by smear and culture in the effective 23 cases at 72 weeks.The swelling superficial and peritoneal lymph nodes were all narrowed or disappeared.Among them,21 cases showed complete absorption of lung lesions by chest radiography,2 cases showed major absorption of lung lesions,and immune function was well rebuilt.Conclusions NTMD is prevalently occurred in AIDS patients with severe immune deficiency.NTMD mostly involves in the lung and often involves many organs.Th

关 键 词：艾滋病 非结核分支杆菌病 抗反转录病毒治疗 

分 类 号：R512.91[医药卫生—内科学] R378.91[医药卫生—临床医学]