获得性免疫缺陷综合征合并肺结核359例临床流行病学研究

Clinical epidemiology of 359 cases of acquired immunodeficiency syndrome and pulmonary tuberculosis co-infection

目的分析获得性免疫缺陷综合征(AIDS)合并肺结核患者的流行病学及临床特征。方法采用回顾性研究方法,收集2011年1月-2015年12月在上海市公共卫生临床中心诊断为AIDS合并肺结核患者的病历资料,并通过门诊随访和电话随访,了解患者的预后情况。运用SPSS 22.0软件,对其特征进行描述性分析。结果 359例AIDS合并肺结核患者中男325例,女34例,30~44岁所占比例最大,42.6%患者出现发现延误;临床症状以发热、咳嗽、体重下降较多见,咯血少见,多数研究对象两肺受累,病变范围≥3个肺野,空洞少见;T-SPOT阳性率偏低,50.7%患者首次检查CD4^+T淋巴细胞计数≤50/μL;69例患者痰结核菌药敏结果显示,43.5%出现耐药;已知抗病毒状态中的患者93.2%已经进行了抗病毒治疗;282例合并肺外结核,合并症及机会性感染以中枢神经系统感染、梅毒、乙型或丙型病毒性肝炎、肺部感染、药物性肝损等为主;333例已知预后情况的患者中53例死亡,其中79.2%在6个月内死亡。结论 AIDS合并肺结核患者年轻患者比例大,影像学表现不典型,T-SPOT阳性率偏低,首次CD4^+T淋巴细胞计数较低,多数患者合并肺外结核,合并症和机会性感染较多,患者多在6个月内死亡。

Objective To analyze the epidemiology and clinical characteristics of acquired immunodeficiency syndrome （AIDS） and pulmonary tuberculosis （TB） co-infection. Methods A retrospective study was conducted with the clinical data of patients diagnosed with AIDS and TB in Shanghai Public Health Clinical Center during the period from 2011 to 2015. The outcome of the patients were evaluated by outpatient and telephone follow-up. The data were analyzed by descriptive analysis using SPSS 22.0 software package. Results A total of 359 patients with AIDS/TB co-infection were included in this analysis, including 325 males and 34 females, the highest proportion in 30-44 age group. The diagnosis was delayed in about 42.6% of the patients. The clinicalsymptoms were mainly fever, cough and weight loss, but hemoptysis uncommon. Both lungs were affected in most cases, with lesions in at least 3 lung fields, but rare pulmonary cavity. T-SPOT.TB test showed lower positive rate. CD4＋T lymphocyte count was 50 cells/μL or less in 50.7% of the patients at their first test. About 43.5% of the 69 patients with antimicrobial susceptibility data showed resistance to therapy. Majority （93.2%） of the patients with known viral status received antiretroviral treatment. Extra-pulmonary tuberculosis was identified in 282 cases. The complication and opportunisticinfection included central nervous system infection, syphilis, hepatitis B virus infection, hepatitis C virus infection, pulmonary infection, and drug-induced liver injury. Of the 333 patients with known outcome, 53 died, most （79.2%, 42/53） within 6 months. Conclusions The patients with A1DS/TB co-infection showed higher proportion of young people. The CT finding was atypical. The patients showed lower positive rate for T-SPOT TB test and lower CD4＋T lymphocyte count at their first test. Most patients had extra-pulmonary tuberculosis and other complications or opportunistic infections.