探讨艾滋病合并结核病患者与T淋巴细胞之间的关系

Exploration of the Relationship between AIDS Combined with TB and T Lymphocytes

目的探讨艾滋病合并结核病患者与T淋巴细胞之间的关系.方法选择2011年6月至2014年6月昆明市第三人民医院接诊的100例艾滋病合并结核病患者进行回顾性分析研究.根据患者的CD4+的值进行分组.观察组为CD4+值<100的患者,共65例;对照组为CD4+值≥100的患者,共35例.比较2组患者一般临床资料、临床类型(继发型肺结核、结核性胸膜炎、结脑、淋巴结核、血行播散型)与CD4+的关系和实验室检查结果 (PPD阳性、痰涂片抗酸染色阳性、结明试验阳性).结果观察组和对照组患者的一般临床资料(年龄、性别)相比较无统计学意义(P>0.05);观察组与对照组的结核性胸膜炎的分别比率分别为45.71%与13.85%,2组比较有统计学意义(χ2=12.322 3,P=0.000 4).观察组与对照组结脑的发病比率分别为8.57%与41.54%,2组比较有统计学意义(χ2=11.773 9,P=0.000 6).观察组与对照组淋巴结核的发病比率分别为14.28%与1.54%,2组比较有统计学意义(χ2=6.554 4,P=0.010 5);观察组中的血行播散型所占比例高于对照组(P<0.05).观察组与对照组的PPD阳性发病比率分别为6.16%与28.57%,2组比较有统计学意义(χ2=9.495 8,P=0.002 1);观察组的痰涂片抗酸染色阳性的比例,结明试验阳性的比例均低于对照组(P<0.05).结论CD4+细胞数发生下降与结核病的发生的成反比关系,CD4+<100/mm3时,结核发生率会明显增加.CD4+值更低更易发生血行播散型、结脑型的结核病的艾滋病.

Objective To explore the relationship between AIDS combined with TB and T lymphocytes. Methods 100 patients with AIDS combined with TB from June 2011 to June 2014 in our hospital were retrospectively analyzed. They were divided into observation and control groups according to CD4^＋ levels. 65 patients with CD4^＋〈 100 in the observation group were treated by using tension-free hernia repair treatment. 35 patients with CD4^＋≥ 100 in the control group were given the traditional hernia repair treatment. The clinical data, clinical types （secondary pulmonary tuberculosis, tuberculous pleurisy, tubercular meningitis, Lymph node tuberculosis and Hematogenous disseminated tuberculosis）, CD 4^＋ levels, and laboratory test results （positive PPD, positive acid-fast staining of sputum smear and MycoDot ） of patients were compared between two groups. Results The clinical data （age, gender） had no significant difference between two groups （P 〉0.05）; the incidence of tuberculous pleurisy in observation group and control group were 45.71% and 13.85%, there was a statistically significant difference（ x^2= 12.322 3, P=0.000 4）. The incidence rate of tuberculous meningitis in the observation group and the control group were 8.57% and 41.54%, there was a statistically significant difference（x^2= 11.773 9, P=0.000 6）. The incidence rate of lymphatic tuberculosis in observation group and control group were 14.28% and 1.54% , there was a statistically significant difference （x^2 =6.554 4, P =0.010 5）. The hematogenous disseminated proportion in observation group was higher than that in the control group （P〈0.05）. The incidence ofpositive PPD in observation group and control group were 6.16% and 28.57%, there was a statistically significant difference（ x^2= 9.495 8, P=0.002 1 ） ; the proportion of sputum smear-positive of acid-fast staining, MycoDot test positive proportion in observation group were lower than that in the control group （P〈0.05）. Conclusion There is a inverse relationship between the count of CD4^＋ cell and tuberculosis＇occurrence, and when the CD4^＋〈 100/mm^3, the incidence of TB will be significantly increased. The lower in values＇CD4^＋, the higher in the incidence of blood disseminated and tuberculous meningitis.