艾滋病合并肠系膜淋巴结结核11例临床分析

Diagnosis and treatment of 11 patients with acquired immune deficiency syndrome complicated with tuberculosis of mesenteric lymph nodes

目的探讨艾滋病合并肠系膜淋巴结结核的临床特点。方法回顾性分析深圳市第三人民医院1999年9月至2008年12月收治的158例艾滋病合并结核病患者，其中诊断为艾滋病合并肠系膜淋巴结结核11例（男7例，女4例）；除1例8岁儿童外，其余10例年龄22～55岁。结果艾滋病合并肠系膜淋巴结结核患者约占艾滋病合并结核病患者的7％，其中8例CD4^＋〈50×10^6／L，3例CD4^＋为（50～100）×10^6／L；临床表现以发热（11／11）、腹痛（11／11）、腹胀（11／11）、盗汗（7／11）、消瘦（10／11）、腹泻（7／11）、贫血（5／11）、腹部包块（3／11）和腹腔积液（1／11）为特点；腹部B型超声扫描示多个肠系膜淋巴结肿大，腹部CT增强扫描示典型环状强化；2例行肠系膜淋巴结组织活检，病理结果均可见结核结节、干酪样坏死物和朗汉斯巨细胞，抗酸染色均为抗酸杆菌阳性。11例均给予抗结核治疗6个月及抗病毒治疗5个月，病灶吸收和消失。结论艾滋病合并肠系膜淋巴结结核的临床表现无特异性，CD4^＋〈50×10^6／L、腹部CT增强扫描出现典型环状强化为其特征性表现。

Objective To study the clinical features of acquired immune deficiency syndrome （AIDS） complicated with tuberculosis of mesenteric lymph nodes. Methods Cases （ n = 153 ） with AIDS complicated with tuberculosis hospitalized in this hospital from September 1999 to December 2008 were retrospectively analyzed. Mesenteric lymph node tuberculosis was found in 11 cases, including 7 males and 4 females. One patient was 8 years old, and the other 10 were over 22 years （ranging from 8 to 55 years）. Results In patients with AIDS complicated with tuberculosis, 7% （11/158） had tuberculosis of the mesenteric lymph nodes. The CD4^＋ cell count was less than 50 × 10^6 cells/L in 8 cases, and （50 - 100） × 10^6 cells/L in 3 cases. The symptoms included fever （ 11/11 ） , abdominal pain （ 11/11 ）, abdominal distension （ 11/11 ）, night sweat （7/11）, weight loss （ 10/11 ）, diarrhea （7/11）, anemia （5/11）, abdominal mass （3/11）, and ascites （1/11）. Abdominal ultrasound showed multiple enlarged mesenteric lymph nodes in all of the 11 cases, and abdominal CT scanning presented typical enhanced ring shadows. Biopsy of mesenteric lymph nodes was obtained from 2 cases, and both revealed tuberculoma, caseous necrosis. Longerhan cell infiltration, and positive stain for fast anti-acid bacilli. Enlarged mesenteric lymph nodes became smaller and disappeared after treatment with antituberculous drugs for 6 months and highly active antiretroviral therapy （HAART） for 5 months in all the 11 patients. Conclusions There were no specific clinical manifestations in AIDS patients with tuberculosis of mesenteric lymph nodes. However, AIDS patients with CD4^＋ cell count less than 50 × 10^6 cells/L might be more prone to developing tuberculosis of the mesenteric lymph nodes. Abdominal CT scanning with typical strengthened ring shadow is suggestive of the diagnosis. Anti-tuberculous therapy combined with HAART is recommended for the treatment of patients with suspected tuberculosis.