1例未合并人类免疫缺陷病毒感染的肺结核患者抗结核治疗期间发生免疫重建炎症反应综合征的诊疗分析  

Diagnosis and Treatment Analysis of Immune Reconstitution Inflammatory Syndrome during Anti-tuberculosis Therapy in One Tuberculosis Patient without HIV Infection

作　　者：陈宇飞 唐佩军[1] 冯彦军 CHEN Yu-fei;TANG Pei-jun;FENG Yan-jun(Department of Tuberculosis,Infectious Diseases Hospital Affiliated to Soochow University(the Fifth People's Hospital of Suzhou),Suzhou Jiangsu 215001,China)

机构地区：[1]苏州大学附属传染病医院(苏州市第五人民医院)结核病科,江苏苏州215001

出　　处：《抗感染药学》2025年第1期28-32,共5页Anti-infection Pharmacy

基　　金：苏州市科技发展计划(SKYD2023158);苏州市姑苏卫生人才科研项目(GSWS2023063);苏州市吴门医派研究专项基金(SKYD2023225)。

摘　　要：目的:分析1例未合并人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染的肺结核患者抗结核治疗期间发生免疫重建炎症反应综合征(immune reconstitution inflammatory syndrome,IRIS)的诊断和治疗要点,为临床IRIS的诊断和治疗提供参考。方法与结果:该患者1个多月前被诊断为肺结核,随即开始抗结核治疗;1周前,患者无明显诱因情况下咳嗽加重,伴发热,且白细胞计数、中性粒细胞百分比(NEUT%)、C反应蛋白等指标均异常升高,临床考虑并发细菌性肺炎,遂予莫西沙星+美罗培南治疗,但未见好转,于是来院就诊;但入院后,完善相关检查,未找到足够证据支持呼吸道病毒感染、细菌感染、真菌感染和非典型病原体感染,甚至排除了药物热的可能,最终考虑为IRIS,随即予甲泼尼龙治疗;3 d后,患者症状明显好转,并且后续胸部CT检查提示肺部病灶缩小、胸腔积液减少。结论:IRIS较少发生于非HIV感染患者,而其临床表现多为原有疾病的加重,加之其诊断的建立须排除其他各种可能的病因,故难度较大,对此应加强对IRIS的认识,以便及时识别IRIS和开展针对性的治疗。Objective:To analyze the key points of diagnosis and treatment of immune reconstitution inflammatory syndrome(IRIS)during anti-tuberculosis therapy in one tuberculosis patient without infection with human immunodeficiency virus(HIV),and provide reference for the clinical diagnosis and treatment of IRIS.Methods and Results:The patient was diagnosed with tuberculosis over a month ago and began anti-tuberculosis therapy immediately.One week ago,the patient had aggravated cough with fever without obvious cause,with abnormal increase of white blood cell count,neutrophil percentage(NEUT%),C-reactive protein and other indicators.It was clinically considered as complicated bacterial pneumonia,so the patient was treated with moxifloxacin+meropenem,and visited the hospital for treatment due to no improvement.However,after admission,relevant examinations showed insufficient evidence to support respiratory viral infection,bacterial infection,fungal infection and atypical pathogen infection,and the possibility of drug fever was even ruled out,then IRIS was finally considered,and methylprednisolone was immediately administrated.After 3 days,the patient's symptoms improved significantly,and subsequent chest CT examination indicated that the lung lesions were reduced and the pleural effusion was reduced.Conclusion:IRIS rarely occurs in non-HIV infected patients,and its clinical manifestations are mostly aggravation of the original disease,and it is difficult to establish its diagnosis without excluding other possible causes.Therefore,it is necessary to strengthen the understanding of IRIS in order to identify IRIS in time and carry out targeted treatment.

关 键 词：肺结核 抗结核治疗 免疫重建炎症反应综合征 诊断 治疗 

分 类 号：R97[医药卫生—药品] R978.3[医药卫生—药学]