艾滋病合并马尔尼菲篮状菌肠道感染患者的临床和病理特点  

Clinical and pathological features of intestinal Talaromycosis marneffei infection in patients with acquired immunodeficiency syndrome

作　　者：黄春明[1] 罗红彬[1] 胡中伟[1] 蔡卫平[1] 郭家伟[1] 詹远京[1] 肖冠英[1] 陈厚志[1] 肖艳华[1] 李凌华[1] Huang Chunming;Luo Hongbin;Hu Zhongwei;Cai Weiping;Guo Jiawei;Zhan Yuanjing;Xiao Guanying;Chen Houzhi;Xiao Yanhua;Li Linghua(Department of Gastroenterology,Guangzhou Eighth People′s Hospital,Guangzhou 510060,China)

机构地区：[1]广州市第八人民医院消化内科,510060

出　　处：《中华传染病杂志》2020年第6期353-358,共6页Chinese Journal of Infectious Diseases

基　　金："十三五"国家科技重大专项(2018ZX10302104-001-007、2018ZX10302103-002);广州市科技创新委员会健康医疗协同创新重大计划课题项目(201803040002)。

摘　　要：目的探讨艾滋病合并马尔尼菲篮状菌(Talaromycosis marneffei,TM)肠道感染患者的临床和病理特点。方法纳入2010年1月至2018年12月于广州市第八人民医院行结肠镜检查的64例艾滋病患者,其中经结肠黏膜病理证实合并TM肠道感染患者32例(合并TM肠道感染组),未合并TM肠道感染患者32例(未合并TM肠道感染组),比较两组患者的临床表现和结肠黏膜病理组织特点。统计学处理采用非参数秩和检验和Fisher确切概率法。结果32例艾滋病合并TM肠道感染组患者中,发热、咳嗽、浅表淋巴结肿大、恶心呕吐、腹肌紧张、腹部压痛和反跳痛分别为28例(87.5%)、16例(50.0%)、13例(40.6%)、9例(28.1%)、8例(25.0%)、20例(62.5%)和12例(37.5%),分别高于未合并TM肠道感染组患者的11例(34.4%)、6例(18.8%)、3例(9.4%)、2例(6.2%)、1例(3.1%)、8例(25.0%)和1例(3.1%),差异均有统计学意义(Fisher确切概率法,均P<0.05)。艾滋病合并TM肠道感染组患者外周血CD4+T淋巴细胞计数、淋巴细胞计数、单核细胞计数、血红蛋白、血小板计数和白蛋白的中位数分别为13.5/μL、0.30×10^9/L、0.16×10^9/L、88 g/L、122×10^9/L和23.5 g/L,分别低于未合并TM肠道感染组的207.0/μL、1.35×10^9/L、0.35×10^9/L、128 g/L、201×10^9/L和37.5 g/L,差异均有统计学意义(Z=-6.111、-6.191、-4.273、-5.353、-2.974、-6.666,均P<0.05)。logistic回归分析显示,CD4+T淋巴细胞计数<50/μL、血红蛋白<90 g/L和粪便隐血试验阳性是艾滋病合并TM肠道感染的独立危险因素。艾滋病合并TM肠道感染患者结肠镜检查主要表现为非连续性溃疡[31.2%(10/32)]、糜烂[31.2%(10/32)]或两者并存[21.9%(7/32)],少数似肿瘤样隆起灶[15.6%(5/32)];结肠黏膜病理特点是溃疡和(或)糜烂[53.1%(17/32)]、黏膜慢性炎症[46.9%(15/32)]和炎性肉芽肿[43.8%(14/32)],特殊染色可见卵圆形或圆形有明显横隔的孢子。艾滋病合并TM肠道感染组27例患者治愈或好转Objective To investigate the clinical and pathological characteristics of acquired immunodeficiency syndrome(AIDS)patients with intestinal Talaromycosis marneffei(TM)infection.Methods A total of 64 AIDS patients who underwent colonoscopy in Guangzhou Eighth People′s Hospital from January,2010 to December,2018 were retrospectively collected.Among them,32 patients were co-infected with TM(AIDS with intestinal TM infection group)and 32 patients were not(AIDS without intestinal TM infection group)according to the colonic mucosa pathology.The clinical manifestations and pathological differences were compared between the two groups.Nonparametric rank sum test and Fisher exact probability method were used for statistical analysis.Results The proportions of patients presented with fever,cough,retroperitoneal lymph nodes tume faction,nausea and vomiting,abdominal muscle tension,abdominal tenderness and rebound pain in AIDS with intestinal TM infection group were 28(87.5%),16(50.0%),13(40.6%),9(28.1%),8(25.0%),20(62.5%)and 12(37.5%),respectively,which were all significantly higher than those in AIDS without intestinal TM infection group 11(34.4%),6(18.8%),3(9.4%),2(6.2%),1(3.1%),8(25.0%)and 1(3.1%),respectively,the differences were statistically significant(Fisher exact test,all P<0.05).The median counts of peripheral blood CD4+T lymphocyte,lymphocytes,monocytes,hemoglobin,platelet and albumin in AIDS with intestinal TM infection group were 13.5/μL,0.30×10^9/L,0.16×10^9/L,88 g/L,122×10^9/L and 23.5 g/L,respectively,which were all significantly lower than those in AIDS without intestinal TM infection group 207.0/μL,1.35×10^9/L,0.35×10^9/L,128 g/L,201×10^9/L and 37.5 g/L,respectively,the differences were all statistically significant(Z=-6.111,-6.191,-4.273,-5.353,-2.974 and-6.666,respectively,all P<0.05).Multivariate logistic regression analysis showed that CD4+T lymphocytes<50/μL,hemoglobin<90 g/L and fecal occult blood positive were independent risk factors for AIDS with intestinal TM infection.The main manifest

关 键 词：获得性免疫缺陷综合征 马尔尼菲篮状菌 肠道感染 临床表现 病理特点 

分 类 号：R512.91[医药卫生—内科学] R5I9[医药卫生—临床医学]