艾滋病患者中播散性马尔尼菲篮状菌病与播散性非结核分枝杆菌病的临床特征  

Clinical Characteristics of Talaromyces Marneffei Disease and Disseminated Nontuberculosis Mycobacterium Disease in AIDS Patients

作　　者：田波 沈银忠[2] 白劲松 刘俊 陈海云 孙建军[2] TIAN Bo;SHEN Yinzhong;BAI Jinsong;LIU Jun;CHEN Haiyun;SUN Jianjun(Dept.of Infection one,The Third People’s Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases,Kunming Yunnan 650041;Dept.of Infection and Immunity,Shanghai Public Health Clinical Center,Shanghai 201508,China)

机构地区：[1]昆明市第三人民医院感染一科/云南省传染性疾病临床医学中心,云南昆明650041 [2]上海市公共卫生临床中心感染免疫科,上海201508

出　　处：《昆明医科大学学报》2022年第7期140-144,共5页Journal of Kunming Medical University

基　　金：云南省科技厅地方高校联合专项基金(202001BA070001-194);上海市公共卫生临床中心院内临床课题(KY-GW-2020-30)。

摘　　要：目的比较艾滋病患者中马尔尼菲篮状菌病与播散性非结核分枝杆菌病患者的临床特征差异及预后的影响因素。方法回顾性收集上海市公共卫生临床中心2015年至2021年艾滋病患者中马尔尼菲篮状菌病为TM组,播散性非结核分枝杆菌病为NTM组,比较2组患者间的临床特征,同时分析预后的影响因素。结果2组患者平均年龄均小于40岁,NTM组24%患者预后不良,TM组预后不良占17%。相比于NTM组,TM组患者白蛋白更低(P=0.003),降钙素原更高(P=0.002),血沉更慢(P=0.011),真菌D葡聚糖更高(P<0.001)。NTM组患者内毒素越低,预后不良的风险越高(P=0.022);白蛋白<30 g/L的患者预后不良的风险高于白蛋白>30 g/L的患者(P=0.017);CD8<250/μL的患者预后不良的风险高于CD8>250/μL的患者(P=0.049)。TM组CD8<250/μL的患者预后不良的风险高于CD8>250/μL的患者(P=0.012);真菌D葡聚糖越低,预后不良的风险越高(P=0.016)。结论在艾滋病患者中,与播散性非结核分枝杆菌相比,马尔尼菲篮状菌感染者白蛋白更低,血沉相对较慢,真菌D葡聚糖水平明显升高且有利于患者预后。2组患者预后均较差,较高的CD8水平预示着较好的预后。Objective To compare the clinical characteristics and analyzing the risk factors for poor prognosis of Talaromyces Marneffei and disseminated Nontuberculosis Mycobacterium disease in AIDS patients.Methods We retrospectively collected the data of cases of Talaromyces Marneffei and disseminated Nontuberculosis Mycobacterium disease in Shanghai Public Health Clinical Center from 2015 to 2021.Then we compared the differences of clinical characteristics between the two groups,the risk factors for poor prognosis were also analyzed.Results The mean age in both groups were younger than 40 years and,the proportion of poor prognosis in NTM group was 24%while it was 17%in TM group.Compared to the NTM group,serum albumin was lower in group TM(P=0.003),Procalcitonin was higher(P=0.002),slower ESR(P=0.011),fungal D-glucan was higher(P<0.001).When CD8 less than 250/μL,the risk of poor prognosis was higher than patients with CD8>250/μL(P=0.049)in the NTM group.Albumin<30 g/L(P=0.017)or endotoxin<6 pg/ml(P=0.022)were both independent risk factors for poor prognosis in the NTM group.The fungal D glucan less than 11pg/mL(P=0.016)or CD8<250/μL(P=0.012)were both independent risk factors for poor prognosis in the TM group.Conclusions In AIDS patients,people infected with Talaromyces Marneffei have lower albumin than disseminated Nontuberculous Mycobacterium and need to pay close attention to timely supplement.Cases in both TM and NTM groups have high mortality.Higher levels of CD8 indicate a better prognosis.

关 键 词：人类免疫缺陷病毒 艾滋病 马尔尼菲篮状菌 非结核分枝杆菌 临床特征 预后 

分 类 号：R512[医药卫生—内科学]