艾滋病合并肺结核的临床特点分析
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摘要
目的分析艾滋病合并肺结核的临床特点,为艾滋病合并肺结核的诊断提供参考。方法选取新乡医学院第一附属医院2016年1月至2019年1月收治并确诊为艾滋病合并肺结核的35例患者作为观察组,以同期收治并确诊为肺结核的37例患者作为对照组,比较两组患者的临床特点。结果两组患者咳嗽、咳痰、咯血症状发生率比较差异无显著性(P>0.05);观察组患者发热、乏力、盗汗、体重减轻的发生率均明显高于对照组,差异有显著性(P<0.05)。观察组患者胸部CT出现浸润性病灶、粟粒样病灶及合并空洞的发生率与对照组比较差异均无显著性(P>0.05);观察组患者胸部CT合并纵隔淋巴结肿大、合并胸腔积液的发生率明显高于对照组,差异有显著性(P<0.05)。观察组患者痰涂片抗酸染色阳性率、痰结核分枝杆菌培养阳性率与对照组比较差异均无显著性(P>0.05);观察组患者结核感染T细胞斑点试验(T-cell spot of tuberculosis test,T-SPOT.TB)阳性率、血清结核抗体阳性率、结核菌素试验阳性率均明显低于对照组,差异有显著性(P<0.05)。观察组CD4+T淋巴细胞水平在0～100个/mm3和100～200个/mm3的患者比例分别为28.57%和42.86%,均明显高于对照组(分别为2.70%和8.11%),差异有显著性(P<0.05)。结论艾滋病合并肺结核的临床症状及胸部CT表现不典型且呈多样性,实验室检查结果阳性率低,缺乏特异性。对于此类患者需要进行全面的检查,提高警惕,为诊断寻找证据。
Objective To analyze the clinical features of AIDS complicated with tuberculosis,and provide more evidence for the diagnosis of AIDS complicated with tuberculosis.Method Thirty-five patients admitted to the First Affiliated Hospital of Xinxiang Medical College from January 2016 to January 2019 and diagnosed with AIDS complicated with pulmonary tuberculosis were selected as the observation group.37 patients who were diagnosed as pulmonary tuberculosis in the same period were the control group.The clinical features of the two groups were compared.Result There was no significant difference in the incidence of cough and hemoptysis between the two groups(P>0.05).The incidence of fever,fatigue,night sweats and weight loss were significantly higher in the observation group than in the control group.The difference was significant(P<0.05).There was no significant difference in the incidence of invasive lesions,miliary lesions and vacancies between the observation group and the control group(P>0.05).The incidence of chest CT with mediastinal lymphadenopathy and pleural effusion in the observation group was significantly higher than that in the control group,and the difference was significant(P<0.05).There was no significant difference in the positive rate of acid-fast staining and the positive rate of Mycobacterium tuberculosis culture in the observation group compared with the control group(P>0.05).The positive rate of T-cell spot of tuberculosis test(T-SPOT.TB),the positive rate of blood tuberculosis antibody,and the positive rate of tuberculin(PPD) test in the observation group were significantly lower than those in the control group.The difference was significant(P<0.05).The proportion of patients with CD4+T lymphocyte levels of 0-100/mm3 and 100-200/mm3 in the observation group was 28.57% and 42.86%,respectively,which were significantly higher than those in the control group(2.70% and 8.11%,respectively).The difference was significant(P<0.05).Conclusion The clinical symptoms and chest CT findings of AIDS complicated with pulmonary tuberculosis are atypical and diverse,and the positive rate of laboratory test results is low and lack of specificity.For such patients,it is necessary to conduct a full-scale examination,to be vigilant,and to find evidence for diagnosis.
Objective To analyze the clinical features of AIDS complicated with tuberculosis,and provide more evidence for the diagnosis of AIDS complicated with tuberculosis.Method Thirty-five patients admitted to the First Affiliated Hospital of Xinxiang Medical College from January 2016 to January 2019 and diagnosed with AIDS complicated with pulmonary tuberculosis were selected as the observation group.37 patients who were diagnosed as pulmonary tuberculosis in the same period were the control group.The clinical features of the two groups were compared.Result There was no significant difference in the incidence of cough and hemoptysis between the two groups(P>0.05).The incidence of fever,fatigue,night sweats and weight loss were significantly higher in the observation group than in the control group.The difference was significant(P<0.05).There was no significant difference in the incidence of invasive lesions,miliary lesions and vacancies between the observation group and the control group(P>0.05).The incidence of chest CT with mediastinal lymphadenopathy and pleural effusion in the observation group was significantly higher than that in the control group,and the difference was significant(P<0.05).There was no significant difference in the positive rate of acid-fast staining and the positive rate of Mycobacterium tuberculosis culture in the observation group compared with the control group(P>0.05).The positive rate of T-cell spot of tuberculosis test(T-SPOT.TB),the positive rate of blood tuberculosis antibody,and the positive rate of tuberculin(PPD) test in the observation group were significantly lower than those in the control group.The difference was significant(P<0.05).The proportion of patients with CD4+T lymphocyte levels of 0-100/mm3 and 100-200/mm3 in the observation group was 28.57% and 42.86%,respectively,which were significantly higher than those in the control group(2.70% and 8.11%,respectively).The difference was significant(P<0.05).Conclusion The clinical symptoms and chest CT findings of AIDS complicated with pulmonary tuberculosis are atypical and diverse,and the positive rate of laboratory test results is low and lack of specificity.For such patients,it is necessary to conduct a full-scale examination,to be vigilant,and to find evidence for diagnosis.
引文
[1]马玙,朱莉贞,潘毓萱.结核病[M].北京:人民卫生出版社,2006:180-182.
[2]Ford N,Getahun H.Service integration to reduce HIV-associated TB mortality[J].Public Health Action,2015,5(4):204.
[3]李拯民.结核病合并人类免疫缺陷病毒感染/艾滋病的流行病[J].中华结核和呼吸杂志,2000,23(11):654-655.
[4]张彦,胡国启,司丽,等.艾滋病合并肺结核与单纯肺结核患者的临床特点对比分析研究[J].传染病信息,2018,31(6):552-554.
[5]中华医学会.临床诊疗指南·结核病分册(2004年版)[M].北京:人民卫生出版社,2005:6-7.
[6]中华医学会感染病学会分会艾滋病学组.中国艾滋病诊疗指南(2018版)[J].协和医学杂志,2019,10(1):35-36.
[7]张海丛,王超,郭立杰,等.CD4+T淋巴细胞及总淋巴细胞变化对艾滋病合并结核病的预测价值研究[J].临床误诊误治,2018,31(10):86-89.
[8]蒋奕,胡腾.合并不同类型结核病的艾滋病患者与CD4+T细胞、结核检查结果的相关性分析[J].海南医学院学报,2018,24(1):34-40.
[9]Balla Rama D,Shabbir SA,Arun K,et al.mHealth:An updated systematic review with a focus on HIV/AIDS and tuberculosis long term management using mobile phones[J].Comput Methods Programs Biomed,2015,122(2):257-265.
[10]陈启,窦红勇.40例艾滋病合并结核病患者的临床实验室特点[J].中华传染病杂志,2016,34(10):613-614.
[11]Williams N,Prosper BN,Anatole PC,et al.Risk assessment of hepatotoxicity among tuberculosis and human immunodeficiency virus/AIDS-coinfected patients under tuberculosis treatment[J].Int J Mycobacteriol,2016,5(4):482-488.
[12]姜聪明,刘晓欢,阮丽萍,等.胸部CT特征分析诊断艾滋病合并肺结核患者的临床价值[J].白求恩医学杂志,2017,15(5):562-564.
[13]Semu M,Fenta TG,Medhin G,et al.Effectiveness of isoniazid preventative therapy in reducing incidence of active tuberculosis among people living with HIV/AIDS in public health facilities of Addis Ababa,Ethiopia:a historical cohort study[J].BMC Infect Dis,2017,17(1):5-6.
[14]Yan I,Korenromp E,Bendavid E.Mortality changes after grants from the Global Fund to Fight AIDS,tuberculosis and malaria:an econometric analysis from 1995 to 2010[J].BMC Public Health,2015,15(1):1-10.
[15]Montales MT,Chaudhury A,Beebe A,et al.HIV-associated TBsyndemic:A growing clinical challenge worldwide[J].Front Public Health,2015,3:281-282.
[2]Ford N,Getahun H.Service integration to reduce HIV-associated TB mortality[J].Public Health Action,2015,5(4):204.
[3]李拯民.结核病合并人类免疫缺陷病毒感染/艾滋病的流行病[J].中华结核和呼吸杂志,2000,23(11):654-655.
[4]张彦,胡国启,司丽,等.艾滋病合并肺结核与单纯肺结核患者的临床特点对比分析研究[J].传染病信息,2018,31(6):552-554.
[5]中华医学会.临床诊疗指南·结核病分册(2004年版)[M].北京:人民卫生出版社,2005:6-7.
[6]中华医学会感染病学会分会艾滋病学组.中国艾滋病诊疗指南(2018版)[J].协和医学杂志,2019,10(1):35-36.
[7]张海丛,王超,郭立杰,等.CD4+T淋巴细胞及总淋巴细胞变化对艾滋病合并结核病的预测价值研究[J].临床误诊误治,2018,31(10):86-89.
[8]蒋奕,胡腾.合并不同类型结核病的艾滋病患者与CD4+T细胞、结核检查结果的相关性分析[J].海南医学院学报,2018,24(1):34-40.
[9]Balla Rama D,Shabbir SA,Arun K,et al.mHealth:An updated systematic review with a focus on HIV/AIDS and tuberculosis long term management using mobile phones[J].Comput Methods Programs Biomed,2015,122(2):257-265.
[10]陈启,窦红勇.40例艾滋病合并结核病患者的临床实验室特点[J].中华传染病杂志,2016,34(10):613-614.
[11]Williams N,Prosper BN,Anatole PC,et al.Risk assessment of hepatotoxicity among tuberculosis and human immunodeficiency virus/AIDS-coinfected patients under tuberculosis treatment[J].Int J Mycobacteriol,2016,5(4):482-488.
[12]姜聪明,刘晓欢,阮丽萍,等.胸部CT特征分析诊断艾滋病合并肺结核患者的临床价值[J].白求恩医学杂志,2017,15(5):562-564.
[13]Semu M,Fenta TG,Medhin G,et al.Effectiveness of isoniazid preventative therapy in reducing incidence of active tuberculosis among people living with HIV/AIDS in public health facilities of Addis Ababa,Ethiopia:a historical cohort study[J].BMC Infect Dis,2017,17(1):5-6.
[14]Yan I,Korenromp E,Bendavid E.Mortality changes after grants from the Global Fund to Fight AIDS,tuberculosis and malaria:an econometric analysis from 1995 to 2010[J].BMC Public Health,2015,15(1):1-10.
[15]Montales MT,Chaudhury A,Beebe A,et al.HIV-associated TBsyndemic:A growing clinical challenge worldwide[J].Front Public Health,2015,3:281-282.