艾滋病合并播散性非结核分枝杆菌病患者71例的临床和实验室检查特征  

Clinical and laboratory characteristics of 71 patients with acquired immunodeficiency syndrome complicated with disseminated nontuberculous mycobacterial disease

作　　者：丁秀荣[1] 刘家琛 陈铭[1] 康艳芳[1] 王晨[1] 娄金丽[1] Ding Xiurong;Liu Jiachen;Chen Ming;Kang Yanfang;Wang Chen;Lou Jinli(Department of Clinical Laboratory,Beijing You′an Hospital,Capital Medical University,Beijing 100069,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：《中华传染病杂志》2022年第10期597-601,共5页Chinese Journal of Infectious Diseases

摘　　要：目的通过分析艾滋病合并播散性非结核分枝杆菌(nontuberculous mycobacteria, NTM)病患者的临床特征和实验室检查特征, 为临床诊治提供依据。方法回顾性分析2016年6月至2021年6月首都医科大学附属北京佑安医院收治的71例艾滋病合并播散性NTM病患者的临床、影像学和病原学资料。结果 71例患者最常见的首发症状是发热, 其次是咳嗽、咳痰, 乏力、纳差, 腹痛、腹泻等, 70.4%(50/71)的患者至少存在2种合并症, 以口腔念珠菌感染、巨细胞病毒感染、梅毒、肺孢子菌肺炎、细菌性肺炎较常见。患者多存在血红蛋白[(87.8±24.2) g/L]和白蛋白[(27.3±7.0) g/L]的明显降低, 以及红细胞沉降率[(59.8±28.6) mm/1 h]和C反应蛋白[(74.7±50.8) mg/L]的明显升高。CD4+T淋巴细胞计数中位数为7×106/L。外周血NTM培养报阳的中位时间为260 h。71例患者中, 鸟分枝杆菌40例(56.3%), 胞内分枝杆菌15例(21.1%), 哥伦比亚分枝杆菌10例(14.1%), 马萨分枝杆菌3例(4.2%), 堪萨斯分枝杆菌3例(4.2%)。影像学检查以肺部斑片影和小结节影最为常见, 患者大多存在纵隔或肺门淋巴结肿大和脾大。结论艾滋病合并播散性NTM病多发生在免疫功能严重低下的患者, 所感染菌种绝大多数属于鸟-胞内分枝杆菌复合群, 尽早获得NTM的病原学证据是指导临床正确诊断和精准治疗的关键。Objective To explore the clinical and laboratory characteristics of acquired immunodeficiency syndrome(AIDS)patients complicated with disseminated nontuberculous mycobacterial(NTM)disease,in order to provide basis for clinical therapy.Methods The clinical findings,imaging and etiological data of the 71 AIDS patients complicated with disseminated NTM disease admitted to Beijing You′an Hospital from June 2016 to June 2021 were retrospectively analyzed.Results Among 71 patients with disseminated NTM disease,the most common initial symptom was fever,followed with cough,expectoration,fatigue,poor appetite,abdominal pain and diarrhea.Seventy point four percent(50/71)of these patients had at least two comorbidities,with oral candida infection,cytomegalovirus infection,syphilis,pneumocystis pneumonia and bacterial pneumonia being the most common.Hemoglobin((87.8±24.2)g/L)and albumin((27.3±7.0)g/L)levels significantly decreased,while erythrocyte sedimentation rate((59.8±28.6)mm/1 h)and C-reactive protein((74.7±50.8)mg/L)levels increased in most cases.The median CD4+T lymphocyte count was 7×106/L.The median time of positive blood culture of NTM was 260 h.Among the 71 patients,40 cases(56.3%)were infected with Mycobacterium avium,15 cases(21.1%)with Mycobacterium intracellulare,10 cases(14.1%)with Mycobacterium colombiense,three cases(4.2%)with Mycobacterium marseillense and three cases(4.2%)with Mycobacterium kansasii.The frequent imaging findings were patchy and nodular shadows in lungs,and most patients had mediastinal or hilar lymph node enlargement and splenomegaly.Conclusions AIDS complicated with disseminated NTM disease is prevalently occurred in patients with severe immune deficiency,and most of the bacteria belong to the Mycobacterium avium-intracellulare complex.Early obtaining positive etiological results of NTM is essential to guide the correct clinical diagnosis and accurate treatment.

关 键 词：获得性免疫缺陷综合征 非结核分枝杆菌 播散性感染 临床特征 实验室检查特征 

分 类 号：R512.91[医药卫生—内科学] R52[医药卫生—临床医学]