按结核病就诊合并HIV／AIDS患者21例临床分析

21 patients with HIV/AIDS complicated with tuberculosis

目的探讨HIV／AIDS合并结核病患者的临床特点，提高HIV／AIDS合并结核病的临床认识。方法对我院2009年6月至2014年8月按结核病就诊合并HIV／AIDS的21例患者的临床特点进行分析。结果21例患者HIV／AIDS传播途径以性传播为主；临床表现主要为发热、咳嗽、咳痰、乏力、气短、胸痛、头痛、腹泻、腹痛、口腔溃疡、体重下降、恶异质、声音嘶哑等；肺结核病影像学表现不典型；合并其他的机会性感染如真菌『生感染、鹅口疮、隐球菌性脑膜炎、卡氏肺孢子虫肺炎等；死亡5人。结论HIV／AIDS合并结核病的临床特点：①症状不典型；②肺结核病影像学表现不典型；③易发生多种机会性感染，如真菌、细菌、病毒感染等；④结核菌素试验多为阴性；⑤血行播散性肺结核及肺外结核多见；⑥痰结核菌检出率低；⑦抗结核效果不满意，死亡率高。

Objective To explore the clinical characteristics of HIV/AIDS patients complicated with tuberculosis and to improve the clinical knowledge of HIV/AIDS complicated with tuberculosis. Methods The clinical characteristics of 21 patients seeing a doctor because of tuberculosis but complicated with HIV/AIDS at our hospital from June, 2009 to August, 2014 were analyzed. Results 21 patients with HIV/A1DS were mainly sexually transmitted. Their clinical manifestations were mainly fever, cough, sputum, fatigue, shortness of breath, chest pain, headache, diarrhea, abdominal pain, oral ulcer, weight loss, heterogeneous, voice hoarse, etc. Imaging findings of tuberculosis were atypical. The patients complicated with other opportunistic infections, such as fungal infections, thrush, cryptococcus meningitis, pneumocystis carinii pneumonia, etc. 5 patients died. Conclusions The clinical characteristics of HIV/AIDS complicated with tuberculosis： ① the symptoms are not typical; ② imaging findings of tuberculosis are atypical; ③ easy to occur a variety of opportunistic infections, such as fungi, bacteria, virus, etc.; ④ the tuberculin tests are mainly negative; ⑤ blood line of disseminated tuberculosis and extrapulmonary tuberculosis are common; ⑥ sputum tuberculosis detection rate is low;⑦ anti-tuberculosis effect is not satisfied and mortality is high.