艾滋病合并播散性非结核分枝杆菌病诊治现状及研究进展  

Current status and research progress of diagnosis and treatment of AIDS with disseminated non⁃tuberculous mycobacterial disease

作　　者：胡静静 沈银忠[2] 刘莉[2] 卢洪洲[3] HU Jingjing;SHEN Yinzhong;LIU Li;LU Hongzhou(Shaoxing Central Hospital,China Medical University,Zhejiang Shaoxing 312000,China;Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;Shenzhen Third People’s Hospital,the Second Affiliated Hospital of Southern University of Science and Technology,Shenzhen 518000,China)

机构地区：[1]中国医科大学绍兴医院,浙江绍兴312000 [2]复旦大学附属公共卫生临床中心,上海201508 [3]南方科技大学第二附属医院(深圳市第三人民医院),广东深圳518000

出　　处：《诊断学理论与实践》2023年第4期402-406,共5页Journal of Diagnostics Concepts & Practice

基　　金：上海市感染性疾病(艾滋病)临床医学研究中心(20MC1920100);艾滋病合并结核病患者中抗病毒治疗方案的优化(SHDC2020CR4005)。

摘　　要：非结核分枝杆菌(non⁃tuberculous mycobacteria,NTM)作为一种机会性致病菌,一般很少在免疫功能正常的人群中引起疾病,除非宿主免疫防御功能受损。获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)患者由于体内人类免疫缺陷病毒(human immunodeficiency virus,HIV)破坏CD4+T淋巴细胞,使得机体免疫功能严重缺陷,当患者感染NTM时,NTM很可能定植,并最终导致患者出现播散性NTM病(disseminated non-tuberculous mycobacterial disease,DNTM)。近年来,全球结核病患者数量呈下降趋势,然而随着AIDS流行、免疫抑制人群数量增加以及实验室NTM检测技术不断进步等因素,AIDS合并NTM的患者数呈上升趋势。与结核病相比,我国公共卫生管理系统未将NTM感染纳入上报系统,而且以往临床重视程度不足,因此系统研究也较少。国内一些地区AIDS合并DNTM患者的5年病死率已高达26.7%,该病极大威胁着患者的生命健康,并消耗了大量医疗资源。我国在NTM的鉴别诊断、治疗、高病死率等方面,面临巨大挑战。因此,迫切需要加强临床对DNTM的临床认知,提升疾病防控及应对能力。Non⁃tuberculous mycobacteria(NTM),an opportunistic pathogen,generally rarely causes disease in immunocompetent populations unless host immune defenses are compromised.Acquired immune deficiency syndrome(AIDS)patients have a severe deficiency in immune function due to the destruction of CD4+T lymphocytes by human immunodeficiency virus(HIV)in the body.When patients are infected with NTM,NTM is likely to colonize and eventually lead to disseminated NTM disease(DNTM).In recent years,the number of tuberculosis patients worldwide has been on a downward trend.However,the number of AIDS patients with NTM is on the rise with the AIDS epidemic,the increase in the number of immunosuppressed people,and the continuous advances in laboratory techniques for NTM testing.Compared with tuberculosis,our public health administration system has not incorporated NTM infection into the reporting system,and the previous clinical attention was insufficient,so the systematic studies are limited.The 5-year case fatality rate of AIDS patients with DNTM in some areas of China was as high as 26.7%.The disease is a great threat to patients'life and health,and consumes a lot of medical resources.At present,China still faces great challenges in differential diagnosis,treatment,and high fatality rate of NTM.Therefore,it is urgent to strengthen the clinical knowledge of DNTM and improve disease prevention and control as well as clinical response capabilities.In this study,the recent research progress of DNTM was reviewed to provide a reference and basis for clinicians to diagnose and treat AIDS with DNTM.

关 键 词：人类免疫缺陷病毒/获得性免疫缺陷综合征 播散性非结核分枝杆菌病 诊断 预后 

分 类 号：R512.91[医药卫生—内科学]