四川地区361例TB/HIV双重感染者的临床分析

Clinical analysis on 361 cases with HIV and TB co-infection in Sichuan area

目的分析四川地区TB/HIV双重感染者的特征。方法回顾性分析10年来本院收治的361例TB/HIV双重感染者的临床特征及预后。结果住院艾滋病患者中TB/HIV双重感染流行率为21.32%(361/1693),病死率为10.53%(38/361);其中78.67%(284/361)患者为肺结核,73.96%(267/361)患者为肺外结核,52.63%(190/361)患者为肺结核及肺外结核同时存在。临床类型以肺外结核为主(73.96%,267/361),继发性肺结核次之(47.37%,171/361),再次为结核性胸膜炎(23.55%,85/361),血型播散型肺结核亦不少见,原发性肺结核少见;最常见的肺外结核为淋巴结结核、结核性脑膜炎,其次是结核性腹膜炎、心包结核,尚存在骨结核、肠结核及盆腔结核;两个部位同时感染最常见(75.35%,272/361);其次是单一部位感染(58.73%,212/361),3个及以上部位感染亦较多见(16.90%,61/361);3个及以上部位感染者病死率最高(18.03%,11/61),几乎是单一部位及两个部位感染病死率的两倍。结论四川地区住院艾滋病患者中TB/HIV双重感染常见,结核多部位感染、肺外结核、肺结核与肺外结核同时存在常见。

Objective To analyze clinical characteristics of patients with HIV and TB co-infection in Sichuan area. Methods Clinical manifestation and prognosis of 361 hospitalized cases with HIV and TB co-infection within resent ten years in Sichuan area were analyzed, retrospectively. Results The incidence of HIV and TB co-infection in hospitalized HIV/AIDS patients was 21.32% （361/1693） and the mortality was 10.53% （38/361）. Among them, 78.67% （284/361） were with pulmonary tuberculosis, 73.96% （267/361） with extrapulmonary tuberculosis, 52.63% （190/361） with both pulmonary tuberculosis and extrapulmonary tuberculosis. The main tuberculosis clinical type was extrapulmonary tuberculosis （73.96%, 267/361）, followed by secondary pulmonary tuberculosis （47.37%, 171/361） and tubercular pleuritis （23.55%, 85/361）. Blood spreads pulmonary tuberculosis wasn＇t rare, but primary pulmonary tuberculosis was rare. The main extrapulmonary tuberculosis was lymph node tuberculosis, followed by tubercular meningitis, tubercular peritonitis and pericardium tuberculosis. Bone tuberculosis, intestinal tuberculosis and the pelvic cavity tuberculosis also existed. The common infection was two spots infection （75.35%, 272/361）, followed by one spot infection （58.73%, 212/361）. Three and above spots infection was also common （16.90%, 61/361）. The highest fatality rate was three and above spot infection group （18.03%, 11/61）, nearly two times of that in one spot infection group and two spots infection group. Conclusions HIV and TB co-infection is common in hospitalized HIV/AIDS patient in Sichuan area. Multi-spots TB infection, extrapulmonary tuberculosis, both pulmonary tuberculosis and extrapulmonary tuberculosis co-existance are common.