HIV感染合并结核病的临床特征及相关影响因素分析
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摘要
目的分析HIV感染合并结核病(tuberculosis, TB)的临床特征,探索HIV感染合并TB的相关影响因素,为临床防治提供依据。方法 350例HIV感染合并TB的患者主要来源于凉山彝族自治州第一人民医院,部分来源于AIDS高发的县医院,另以分层抽样法抽取200例单一HIV感染者作为对照。收集患者人口学资料、临床表现统计资料、胸部X线/CT影像学资料及实验室检查资料,统计治疗情况、吸烟史、吸毒史、性病史、工作性质等,分析HIV感染合并TB的相关因素。结果 HIV感染合并TB患者主要为已婚中年男性,文化程度低,多为农民。其中有吸烟史者占96.00%,静脉吸毒史者占65.71%,性病史者占32.00%,冶游史者占28.29%。TB以肺结核合并肺外结核为主,肺结核合并肺外结核患者CT表现中斑片或大片实变影、累及胸膜或淋巴结、纵隔内淋巴结增大、胸腔积液、心包积液及存在空洞的占比明显高于单纯性肺结核(P均<0.05)。350例患者中23.43%的患者痰检涂阳,其余涂阴者经利福平耐药实时荧光定量核酸扩增系统检测或TB-PCR检测阳性,患者对利福平耐药率为18.86%;72.00%的患者抗病毒治疗依从性良好,抗结核治疗治愈者91例,完成疗程者166例,共占73.43%。Logistic回归分析显示性别、年龄、文化程度、吸烟史、静脉吸毒史、性病史、冶游史、近期CD4+T细胞计数均为HIV感染合并TB的危险因素(P均<0.05)。结论凉山彝族自治州HIV感染合并TB患者的临床特征复杂,治疗现状不乐观,其发病受性别、年龄、文化程度、吸烟史、静脉吸毒史、性病史、CD4+T细胞计数等多种因素的影响,应加强本地区相关的宣教工作及防艾禁毒工作,并制定针对性防治策略。
Objective To analyze the clinical features of HIV infection combined with tuberculosis(TB), explore the relevant influencing factors of HIV infection combined with TB, and provide clinical basis for clinical prevention and treatment of such infection. Methods Three hundred and fifty patients with HIV infection combined with TB were dominantly selected from the First People's Hospital of Liangshan Yi Autonomous Prefecture, and partly from county hospitals with a high incidence of AIDS. Another 200 cases of single HIV infection were selected by stratified sampling method, as control group. The demographic data, clinical manifestation statistical data, chest X-ray film/CT imaging and laboratory examination data of all patients were collected. Their treatment, smoking history, drug abuse history, history of venereal disease and work nature were statistically analyzed. Factors related to HIV infection combined with TB were also statistically analyzed. Results HIV-infected patients with TB were mainly married middle-aged men, their education level was low and their occupations mostly were farmers. The percentages of people having smoking history, having intravenous drug abuse history, having history of venereal disease and having history of visiting prostitutes were 96.00%, 65.71%, 32.00% and 28.29% respectively. The type of TB infection was mainly pulmonary tuberculosis plus extrapulmonary tuberculosis. CT scans of pulmonary tuberculosis patients with extrapulmonary tuberculosis, showing patches or large consolidation, involving pleural or lymph nodes, mediastinal lymph node enlargement, pleural effusion, pericardial effusion, and the cavities were obviously higher than those of simple tuberculosis patients(P <0.05). Among the involved 350 patients, 23.43% of patients were sputum smear-positive, and the remaining negative cases was positive by Xpert MTB/RIF or TB-PCR, and the resistance rate to rifampicin of patients was 18.86%; 72.00% of patients had good compliance of antiviral therapy. Ninety-one patients were cured by anti-tuberculosis treatment and 166 cases had completed the course of treatment, accounting for 73.43%. Logistic regression analysis showed that gender, age, educational level, smoking history, history of intravenous drug abuse, history of venereal disease, history of visiting prostitutes, and CD4~+ T cells count were regarded risk factors for HIV/TB infection(P <0.05). Conclusions The clinical features of patients with HIV infection combined with TB in Liangshan Yi Autonomous Prefecture are complex. The treatment status is not optimistic and the incidence is influenced by many factors, such as gender, age, educational level, smoking history, history of intravenous drug abuse, history of venereal disease and CD4~+ T cells count. It is necessary to strengthen the related propaganda and education, as well as drug control and AIDS prevention in this region, and formulate targeted control strategies.
Objective To analyze the clinical features of HIV infection combined with tuberculosis(TB), explore the relevant influencing factors of HIV infection combined with TB, and provide clinical basis for clinical prevention and treatment of such infection. Methods Three hundred and fifty patients with HIV infection combined with TB were dominantly selected from the First People's Hospital of Liangshan Yi Autonomous Prefecture, and partly from county hospitals with a high incidence of AIDS. Another 200 cases of single HIV infection were selected by stratified sampling method, as control group. The demographic data, clinical manifestation statistical data, chest X-ray film/CT imaging and laboratory examination data of all patients were collected. Their treatment, smoking history, drug abuse history, history of venereal disease and work nature were statistically analyzed. Factors related to HIV infection combined with TB were also statistically analyzed. Results HIV-infected patients with TB were mainly married middle-aged men, their education level was low and their occupations mostly were farmers. The percentages of people having smoking history, having intravenous drug abuse history, having history of venereal disease and having history of visiting prostitutes were 96.00%, 65.71%, 32.00% and 28.29% respectively. The type of TB infection was mainly pulmonary tuberculosis plus extrapulmonary tuberculosis. CT scans of pulmonary tuberculosis patients with extrapulmonary tuberculosis, showing patches or large consolidation, involving pleural or lymph nodes, mediastinal lymph node enlargement, pleural effusion, pericardial effusion, and the cavities were obviously higher than those of simple tuberculosis patients(P <0.05). Among the involved 350 patients, 23.43% of patients were sputum smear-positive, and the remaining negative cases was positive by Xpert MTB/RIF or TB-PCR, and the resistance rate to rifampicin of patients was 18.86%; 72.00% of patients had good compliance of antiviral therapy. Ninety-one patients were cured by anti-tuberculosis treatment and 166 cases had completed the course of treatment, accounting for 73.43%. Logistic regression analysis showed that gender, age, educational level, smoking history, history of intravenous drug abuse, history of venereal disease, history of visiting prostitutes, and CD4~+ T cells count were regarded risk factors for HIV/TB infection(P <0.05). Conclusions The clinical features of patients with HIV infection combined with TB in Liangshan Yi Autonomous Prefecture are complex. The treatment status is not optimistic and the incidence is influenced by many factors, such as gender, age, educational level, smoking history, history of intravenous drug abuse, history of venereal disease and CD4~+ T cells count. It is necessary to strengthen the related propaganda and education, as well as drug control and AIDS prevention in this region, and formulate targeted control strategies.
引文
[1]袁源,刘宏伟,刘春华,等.河南省商丘市艾滋病抗病毒治疗病毒未抑制患者HIV-1耐药毒株的变异[J].郑州大学学报(医学版),2016,51(5):643-646.
[2]郑志刚,唐振柱,陆庆林,等.结核分枝杆菌和HIV双重感染者生存时间的影响因素分析[J].中华预防医学杂志,2015,49(10):907-913.
[3]Castro KG, Ward JW, Slutsker L, et al. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents, and adults[J]. MMWR Recomm Rep, 1993, 41(4):802-810.
[4]中华人民共和国卫生部. WS288-2008肺结核诊断标准[M].北京:人民卫生出版社,2008:1-16.
[5]卢洁,郝义彬,王晓楠,等.郑州市某综合性医院医务人员结核病防护知识、行为及影响因素[J].郑州大学学报(医学版),2013,48(6):762-765.
[6]杨蕊,邱玉冰,苏玮玮,等.云南省TB/HIV双重感染患者抗结核治疗死亡危险因素生存分析[J].中华疾病控制杂志,2016,20(12):1212-1215.
[7]梁大斌,林玫,蓝如束,等.广西壮族自治区HIV与MTB双重感染患者的临床特征分析[J].中国防痨杂志,2017,39(7):717-722.
[8]林玫,崔哲哲,蓝如束,等. HIV感染者和艾滋病患者并发潜伏结核感染的特征及其影响因素[J].中国防痨杂志,2017,39(11):1204-1211.
[9]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.
[10]王芸,侯景龙,杨蕊,等.云南省2010—2013年结核菌/艾滋病病毒双重感染者流行特征[J].公共卫生与预防医学,2015,26(3):8-11.
[11]NarendranG,AndradeBB,PorterBO, etal.Paradoxical tuberculosis immune reconstitution inflammatory syndrome(TB-IRIS)in HIV patients with culture confirmed pulmonary tuberculosis in india and the potential role of IL-6 in prediction[J]. PLoS One, 2013, 8(5):e63541.
[12]王涛,张荣萍,宋立江,等.艾滋病合并肺结核与单纯性肺结核的CT表现对比研究[J].四川医学,2015,36(9):1344-1346.
[13]中华医学会感染病学分会艾滋病学组. HIV合并结核分枝杆菌感染诊治专家共识[J].中华临床感染病杂志, 2017,10(2):81-90.
[14]伍秋云,卢祥婵,黄爱春,等. 126例HIV/结核分枝杆菌合并感染临床观察[J].传染病信息,2015,28(2):108-111.
[15]林定文,崔哲哲,刘飞鹰,等.广西TB/HIV双重感染筛查与诊疗管理现况分析[J].重庆医学,2017,46(35):4987-4990.
[16]徐祖辉,张传芳,肖军,等.湖南省HIV/AIDS人群中结核病患病及其影响因素研究[J].中国医师杂志,2016,18(2):187-190.
[2]郑志刚,唐振柱,陆庆林,等.结核分枝杆菌和HIV双重感染者生存时间的影响因素分析[J].中华预防医学杂志,2015,49(10):907-913.
[3]Castro KG, Ward JW, Slutsker L, et al. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents, and adults[J]. MMWR Recomm Rep, 1993, 41(4):802-810.
[4]中华人民共和国卫生部. WS288-2008肺结核诊断标准[M].北京:人民卫生出版社,2008:1-16.
[5]卢洁,郝义彬,王晓楠,等.郑州市某综合性医院医务人员结核病防护知识、行为及影响因素[J].郑州大学学报(医学版),2013,48(6):762-765.
[6]杨蕊,邱玉冰,苏玮玮,等.云南省TB/HIV双重感染患者抗结核治疗死亡危险因素生存分析[J].中华疾病控制杂志,2016,20(12):1212-1215.
[7]梁大斌,林玫,蓝如束,等.广西壮族自治区HIV与MTB双重感染患者的临床特征分析[J].中国防痨杂志,2017,39(7):717-722.
[8]林玫,崔哲哲,蓝如束,等. HIV感染者和艾滋病患者并发潜伏结核感染的特征及其影响因素[J].中国防痨杂志,2017,39(11):1204-1211.
[9]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.
[10]王芸,侯景龙,杨蕊,等.云南省2010—2013年结核菌/艾滋病病毒双重感染者流行特征[J].公共卫生与预防医学,2015,26(3):8-11.
[11]NarendranG,AndradeBB,PorterBO, etal.Paradoxical tuberculosis immune reconstitution inflammatory syndrome(TB-IRIS)in HIV patients with culture confirmed pulmonary tuberculosis in india and the potential role of IL-6 in prediction[J]. PLoS One, 2013, 8(5):e63541.
[12]王涛,张荣萍,宋立江,等.艾滋病合并肺结核与单纯性肺结核的CT表现对比研究[J].四川医学,2015,36(9):1344-1346.
[13]中华医学会感染病学分会艾滋病学组. HIV合并结核分枝杆菌感染诊治专家共识[J].中华临床感染病杂志, 2017,10(2):81-90.
[14]伍秋云,卢祥婵,黄爱春,等. 126例HIV/结核分枝杆菌合并感染临床观察[J].传染病信息,2015,28(2):108-111.
[15]林定文,崔哲哲,刘飞鹰,等.广西TB/HIV双重感染筛查与诊疗管理现况分析[J].重庆医学,2017,46(35):4987-4990.
[16]徐祖辉,张传芳,肖军,等.湖南省HIV/AIDS人群中结核病患病及其影响因素研究[J].中国医师杂志,2016,18(2):187-190.