艾滋病患者合并分枝杆菌血流感染的临床特征分析  

Analysis of clinical characteristics of bloodstream infection of mycobacteria in AIDS patients

作　　者：丁秀荣[1] 刘家琛 陈淑华 康艳芳[1] 王晨[1] 娄金丽[1] Ding Xiurong;Liu Jiachen;Chen Shuhua;Kang Yanfang;Wang Chen;Lou Jinli(Departments of Clinical Laboratory,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China;School of Medical Imaging,Tianjin Medical University,Tianjin 300203,China)

机构地区：[1]首都医科大学附属北京佑安医院临床检验中心,北京100069 [2]天津医科大学医学影像学院,天津300203

出　　处：《中国防痨杂志》2022年第8期821-826,共6页Chinese Journal of Antituberculosis

基　　金：首都卫生发展科研专项公共卫生项目(首发2021-1G-4301、4302)。

摘　　要：目的:了解艾滋病(AIDS)合并分枝杆菌血流感染的临床特征,提高对AIDS患者结核分枝杆菌(MTB)感染和非结核分枝杆菌(NTM)感染临床特征的鉴别诊断水平。方法:采用回顾性研究方法,搜集2016年6月至2021年6月首都医科大学附属北京佑安医院确诊并收治的135例AIDS合并分枝杆菌血流感染的住院患者为研究对象,收集其临床资料,包括病史、症状、体征、实验室检查结果、病原学特点、影像学特征和诊治情况。分析比较合并MTB感染者和NTM感染者的相关资料。结果:(1)病原学检查:135例研究对象中MTB感染者64例(47.4%),NTM感染者71例(52.6%)。NTM分离株中以鸟分枝杆菌为主(40株,56.3%)。(2)临床表现:研究对象的临床表现主要为发热(83.7%,113/135)、咳嗽(44.4%,60/135)、乏力(30.4%,41/135)、腹泻(25.2%,34/135)等。MTB感染组发热(92.2%,59/64)、咳嗽(56.3%,36/64)、咳痰(32.8%,21/64)的发生率,以及体温峰值[(39.0±1.0)℃]均明显高于NTM感染组[分别为76.1%(54/71)、33.8%(24/71)、11.3%(8/71)、(38.6±1.2)℃],差异均有统计学意义(χ^(2)=6.421,P=0.011;χ^(2)=6.869,P=0.009;χ^(2)=9.263,P=0.002;t=2.025,P=0.045)。(3)实验室检查:MTB感染组降钙素原[1.57(0.42,6.71)ng/ml]、白细胞计数[6.62(3.39,8.78)×10^(9)/L]、血红蛋白[(95.5±21.5)g/L]、痰涂片抗酸染色阳性率(45.3%,29/64)均明显高于NTM感染组[分别为0.31(0.11,1.80)ng/ml、4.03(2.81,6.20)×10^(9)/L、(78.7±14.6)g/L、11.2%(8/71)],差异均有统计学意义(Z=-3.433,P=0.001;Z=-2.798,P=0.005;t=5.344,P<0.001;χ^(2)=19.609,P<0.001)。MTB感染组CD4+T淋巴细胞计数为14(8,55)×10^(6)/L,明显高于NTM感染组的7(2,20)×10^(6)/L,差异有统计学意义(Z=-3.434,P=0.001)。(4)影像学表现:MTB感染组粟粒影(17.2%,11/64)与胸腔淋巴结肿大(85.9%,55/64)的发生率高于NTM感染组[分别为1.4%(1/71)和71.8%(51/71)],差异均有统计学意义(χ^(2)值分别为8.491和3.971,P值分别为0.004和0.046)。(5)治疗转归:MTB感染组�Objective:To explore the clinical characteristics of mycobacterium bloodstream infection in AIDS patients and to improve the differential diagnosis of Mycobacterium tuberculosis(MTB)and nontuberculous mycobacteria(NTM)infection.Methods:A retrospective survey was conducted in 135 AIDS patients with mycobacterium bloodstream infection admitted to Beijing Youan Hospital from June 2016 to June 2021.The clinical data,including medical history,symptoms,signs,laboratory results,etiological characteristics,imaging characteristics and treatment were collected and the data of MTB patients and NTM patients were analyzed and compared.Results:(1)Etiological examination:among the 135 patients,64(47.4%)were infected with MTB and 71(52.6%)were infected with NTM.Mycobacterium avium was dominant in NTM isolates(40 strains,56.3%).(2)Clinical manifestations:the main clinical manifestations of those patients were fever(83.7%,113/135),followed with cough(44.4%,60/135),fatigue(30.4%,41/135),diarrhea(25.2%,34/135),etc.The incidence rate of fever,cough,expectoration and the peak body temperature in MTB infection group were significantly higher than those of NTM group(92.2%(59/64)vs.76.1%(54/71),χ^(2)=6.421,P=0.011;56.3%(36/64)vs.33.8%(24/71),χ^(2)=6.869,P=0.009;32.8%(21/64)vs.11.3%(8/71),χ^(2)=9.263,P=0.002;and(39.0±1.0)℃vs.(38.6±1.2)℃,t=2.025,P=0.045,respectively).(3)Laboratory examination:procalcitonin,white blood cell count,hemoglobin and positive rate of smear acid-fast in MTB group were significantly higher than those in NTM group(1.57(0.42,6.71)ng/ml vs.0.31(0.11,1.80)ng/ml,Z=-3.433,P=0.001;6.62(3.39,8.78)×10^(9)/L vs.4.03(2.81,6.20)×10^(9)/L,Z=2.798,P=0.005;(95.5±21.5)g/L vs.(78.7±14.6)g/L,t=5.344,P<0.001;45.3%(29/64)vs.11.2%(8/71),χ^(2)=19.609,P<0.001,respectively),and the differences were statistically significant.There was significant difference on the CD4+T lymphocyte count between the MTB group and the NTM group(14(8,55)×10^(6)/L vs.7(2,20)×10^(6)/L,Z=-3.434,P=0.001).(4)Imaging findings:the incidence of miliar

关 键 词：获得性免疫缺陷综合征 分枝杆菌属 细菌感染 疾病特征 诊断 鉴别 

分 类 号：R51[医药卫生—内科学]