117例HIV/AIDS病人合并肺结核的临床特点

Clinical characteristics of 117 cases of HIV/AIDS patients complicated with pulmonary tuberculosis

目的分析艾滋病病毒（HIV）感染者／艾滋病（AIDS）病人合并肺结核的临床特点，提高诊疗水平。方法对1997年7月至2011年7月间，住院的HIV／AIDS合并肺结核的病人，回顾分析其末梢血CD＋T淋巴细胞（简称CD4细胞）计数与结核菌素纯蛋白衍生物试验（PPD试验）、痰涂片、结核抗体以及纤维支气管镜灌洗液涂片的关系。结果117例病人中，cD。细胞计数〈50个／mm3时，PPD试验无阳性反应，痰涂片阳性率为20．0％（3／15），结核抗体阳性率为26．7％（4／15）；CD4细胞计数在50～200个／mm3时，PPD试验阳性率为25．0％（16／64），痰涂片阳性率为40．6％（26／64），结核抗体阳性率为35．9％（23／64）；CD4细胞计数在200～500个／mm3时，PPD试验阳性率为55．3％（21／38），痰涂片阳性率为60．5％（23／38），结核抗体阳性率为52．6％（20／38），其中65例痰涂片阴性患者经纤维支气管镜灌洗液涂片有29例（44．6％）抗酸杆菌阳性；CD4细胞计数〉500个／mm3时，痰涂片阳性率为71．4％（5／7），结核抗体阳性率为57．1％（4／7）。结论CD4细胞计数在500个／mm3以上时，痰涂片阳性率、结核抗体阳性率与HIV阴性肺结核检测相近，CD4细胞计数在200个／mm3以下时，临床表现较为复杂，数值越低合并肺结核症状越重，PPD试验反应、痰涂片、结核抗体以及纤维支气管镜灌洗液涂片阳性率越低。

Objective To study the clinical characteristics of pulmonary tuberculosis in HIV/AIDS and improve the diagnosis and treatment of pulmonary tuberculosis in HIV/AIDS patients. Methods HIV / AIDS patients complicated with pulmonary tuberculosis from 1997 July to 2011 July were reviewed. Relationship of CD＋ T lymphocyte count（hereinafter referred to as the CD4 count） with purified protein derivative of tuberculin test （PPD test） reaction, sputum smear, tuberculosis antibody and smear of bronchofibroscope lavage fluid were analyzed. Results There were 117 inpatients. When CD4 counts were less than 50 cells/mm3 , there was no positive reaction of PPD test, the positive rate of sputum smear was 20.0% （3/15）, and the positive rate of tuberculosis antibody was 26.7% （4/15）. When CD4 countswere between 50-200 cells/mm3 , the positive rate of PPD test was 25.0% （16/64）, the positive rate of sputum smear was 40. 6%（26/64）, and positive rate of tuberculosis antibody was 35. 9% （23/64）. When CD4 countswere between 200-500 cells/mm3 , the positive rate of PPD test was 55.3 % （21/38）, the positive rate of sputum smear was 60, 5% （23/38）,and the positive rate of tuberculosis antibody was 52.6% （20/38）. Among 65 cases of sputum smear negative patients, 29 （44.6 %） were positive acid-fast stain by fiberoptic bronchoscopy lavage fluid smear. When CD4 counts were above 500 cells/mm3 , the sputum smear positive rate was 71.4% （5/7）, and the positive rate of tuberculosis antibody was 57.1%（4/7）. Conclusions When CD4 counts were above 500 cells/mm3 , the positive rate of sputum smear, tuberculosis antibodywas close to that in HIV negative patients. When CD4 counts were less than 200 cells/ram3, the clinical manifestation was complicated. The lower the CD4 counts, the more severe the symptoms, and the lower rate of PPD test reaction, sputum smear, tuberculosis antibody and fiberoptic bronchoscopy lavage fluid smear.