HIV阳性和阴性非结核分枝杆菌感染患者比较分析

Comparative analysis of HIV-infected and non-HIV-infected patients with nontuberculous mycobacteria

目的探索HIV阳性和HIV阴性非结核分枝杆菌患者基本情况、感染菌种和耐药方面的异同。方法对广西南宁市第四人民医院结核病科一病区2018年1月-2019年6月确诊的非结核分枝杆菌患者50例进行回顾性分析,分为HIV阳性组11例,HIV阴性组39例。比较两组年龄、CD+T细胞计数、血红蛋白、非结核分枝杆菌菌种、非结核分枝杆菌单药耐药和多药耐药的情况,应用SPSS 23.0软件进行统计分析。结果HIV阳性组CD4+T值低于HIV阴性组,平均值分别为47个/μL,617个/μL,HIV阳性组有45.45%属于非结核分枝杆菌播散性感染,HIV阴性组均为肺部感染,两组CD4+T和感染病灶比较差异均有统计学意义(P<0.05);两组均以感染鸟分枝杆菌最多,分别占63.64%和35.90%,但差异无统计学意义(P>0.05);两组对结核药物的耐药率在46.00%~94.00%之间,HIV阳性组耐药率更高,仅丙硫异烟胺耐药率差异有统计学意义(P<0.05);两组患者均表现为结核药物多药耐药发生率高,含丙硫异烟胺多药耐药率34.00%,相对较低,其他多药耐药情况达62.00%~84.00%;HIV阳性组多药耐药率普遍比HIV阴性组高,但差异无统计学意义(P>0.05)。结论广西HIV阳性组比较HIV阴性组非结核分枝杆菌患者,免疫水平更低、播散感染更多,两组均以鸟分枝杆菌为主,HIV阳性组对丙硫异烟胺的耐药高于HIV阴性组,但均表现为对结核一线、二线药物普遍高耐药率。

Objective To explore the differences of basic features,strains of nontuberculosis mycobacteria and drug resistance between HIV positive and HIV negative patients.Methods A retrospective analysis was conducted on 50patients with nontuberculous mycobacterium from Jan 2018 to Jun 2019 in NO.1 Department of Tuberculosis in Nanning Fourth People’s Hospital of Guangxi.There were 11 patients in the HIV positive group and 39 patients in the HIV negative group.The age,CD4+T cell count,hemoglobin,isolation strains of nontuberculosis mycobacterium,rate of single drug resistance and multi-drug resistance were compared between two groups.SPSS 23.0 software was used for statistical analysis.Results Patients in HIV positive group had much lower average CD4+T count(47 cell/μL vs.617 cell/μL)and more disseminated infection(45.45%vs.0.00%)than that of HIV negative group,the difference were statistically significant(P<0.05).Mycobacterium avium strain comprised of the most common strain in HIV positive group and HIV negative group,accounting for 63.64%and 35.90%,respectively,without statistically significant(P>0.05);both groups had high single drug-resistance(46.00%-94.00%)and high multi-drug resistance ranged from 62.00%-84.00%,except resistance to protionamide was comparable lower,34.00%.Conclusions Compared with HIV negative infected with nontuberculous mycobacteria patients,HIV positive patients in Guangxi had lower immune levels and more disseminated infections.Mycobacterium avium was dominant in both groups.HIV positive patients were more resistant to isonicotinamide than HIV negative patients,but both showed a generally high resistance rate to first-line and second-line drugs of tuberculosis.