艾滋病合并痰菌涂阳肺结核病人临床分析

Clinical analysis of sputum smear positive pulmonary tuberculosis patients with AIDS

目的了解艾滋病合并痰菌涂阳肺结核病人的临床特点。方法回顾性分析2014年1月至2017年1月西南医科大学附属医院感染科收治的18例艾滋病合并痰抗酸杆菌涂阳,并经聚合酶链式反应证实为结核分枝杆菌感染病人的临床资料。结果18例病人,男15例,女3例,年龄(48.6±13.5)岁,CD4^+T淋巴细胞(简称CD4细胞)计数平均(55.96±52.52)个/μL,临床症状以发热、咳嗽、咳痰、体重下降多见,所有病人均合并其他机会性感染,合并肺外结核7例,治愈6例,死亡5例,好转3例,失访4例。结论艾滋病合并痰菌涂阳肺结核病人治疗效果差,CD4细胞计数低,易合并其他机会性感染及肺外结核,应注意区分非结核分枝杆菌感染,个体化、及时的抗结核治疗、适时的抗病毒治疗可能改善预后。

Objective To investigate the clinical features of sputum smear positive pulmonary tuberculosis in AIDS patients.Methods A retrospective analysis was made on 18 cases of AIDS-positive sputum smear-positive smears treated in the affiliated hospital from January 2014to January 2017.The clinical data of patients with mycobacterium tuberculosis infection confirmed by PCR were retrospectively analyzed.Results Among the 18 patients, 15 were males and 3 females,with a mean age of 48.6±13.5 years old.CD4 cell count was 55.96±52.52)/μL, and clinical symptoms included fever,cough,sputum,and weight loss.All patients suffered other opportunistic infections,with 7 cases complicated with extrapulmonary tuberculosis and 6 cases cured,and 5cases of death and 3 cases of improvement.Conclusion AIDS patients with smear-positive pulmonary tuberculosis have poor treatment effect,low CD4 cell count,and are easy to be associated with other opportunistic infections and extrapulmonary tuberculosis.Attention should be paid to differentiate non-tuberculous mycobacterial infection,individualized and timely anti-TB treatment and antiviral treatment may improve prognosis.