艾滋病合并结核感染233例临床分析

Clinical analysis on 233 cases of AIDS complicated with tuberculosis

目的探讨艾滋病(AIDS)合并结核(TB)感染的临床特点,提高对本病的认识。方法对1990-2009年1020例AIDS住院患者的临床资料进行回顾性分析,总结AIDS合并TB感染的临床特点。结果 1020例AIDS患者中共有233例发生TB感染,感染率为22.8%。TB感染部位以肺部最多见(43.8%),其次是淋巴结(28.8%),腹腔(12.0%)。223例(95.7%)血沉﹥20mm/h,200例(85.8%)CD4+T细胞计数﹤200个/μl。合并贫血148例(63.5%),消化道念珠菌感染92例(39.5%),肺炎62例(26.6%)。诊断结核病的主要方法为影像学诊断,其中CT诊断156例(67.0%),X线片诊断56例(24.0%)。173例(74.2%)患者经抗结核治疗后预后良好。结论 AIDS合并TB感染呈逐年上升趋势,播散性感染及肺外感染多见,但感染部位仍以肺部最常见。合并TB感染者可同时存在其他多种合并症。早期规范抗结核治疗可获得较好疗效。

Objective To study the characteristics of AIDS complicated with tuberculosis （TB）, improve the recognition of AIDS complicated with TB. Methods Clinical data of HIV co-infected with TB from 1020 cases of AIDS hospitalized from January 1990 to December 2009 with complete medical records were analyzed retrospectively. Results Of the 1020 cases of AIDS, 233 were co-infected with TB, with the infection rate of 22.8%. The most common site of infection was lung （43.8%）, followed by lymph node tuberculosis （28.8%） and abdominal TB （12.0%）. ESR was abnormal in 95.7% of patients （223 cases）. Patients with CD4^＋ T cell counts less than 200/μl accounted for 85.8% （200 cases）. Other complications included anemia （148 cases, 63.5%）, gastrointestinal candidiasis （92 cases, 39.5%） and pneumonia （62 cases, 26.6%）. Diagnosis was mainly depended on imaging method, with 156 cases （67.0%） diagnosed by CT, and 56 cases （24.0%） by X-rays. After standard tuberculosis treatment, 173 cases （74.2%） had a good prognosis. Conclusion The number of AIDS complicated with tuberculosis shows an annual increasing trend. Disseminated infection and extrapulmonary TB are common, but lungs are still the most common sites of all infections. Patients with tuberculosis often have a variety of other complications. Early standard treatment can obtain better results.