HIV/TB双重感染患者结核病诊断方法的临床意义

Clinical significance of diagnosis of tuberculosis in patients with HIV/TB double infection

目的比较HIV/TB双重感染患者结核病的各检查手段的临床意义。方法回顾性分析2008年1月-2016年10月在天津市海河医院住院诊疗的94例HIV/TB患者的资料,并与无合并HIV的结核患者进行对比,分析PPD、TTSPOT.TB、血沉、结核抗体、痰结核菌等各种检查手段的阳性率。结果 HIV/TB双重感染患者的男:女=81:13,平均年龄为(44.1±14.0)岁,临床症状不典型,继发性肺结核的比例最高,占62.8%(59/94),其次淋巴结结核占20.2%(19/94),血型播散型肺结核占9.6%(9/94),肠结核占14.9%(14/94),结核性胸膜炎占23.4%(22/94),总共肺外结核患者占59.6%(56/94);PPD、结核抗体、痰抗酸染色、痰液培养阳性率低,血沉、T-SPOT.TB阳性率高,但是仅HIV/TB双重感染的结核抗体、血沉和无合并HIV的结核患者检查阳性率差异有统计学意义(P<0.05)。结论 HIV/TB双感染患者的结核病症状不典型,但是各种检查的联合诊断对于HIV感染患者的早期诊断活动性结核病更有意义,使HIV/TB双重感染患者得到尽早的诊疗。

Objective To explore the clinical significance of each inspection means for tuberculosis in patients with HIWTB double infection. Methods The data of 94 HIV/TB patients hospitalized in Tianjin Haihe Hospital from January 2008 to October 2016 were retrospectively analyzed and compared with the tuberculosis patients without HIV. The positive rate of various inspection including PPD, T-SPOT.TB, ESR, TB antibody, sputum examination for tuberculosis were analysed. Results With M：F=81：13 and average age of （44.1_＋14.0） years, the clinical symptom of tuberculosis patients co-infected with HIV was not typical. The secondary pulmonary tuberculosis took the highest rate with 62.8%（59/94）, while lymphoid tuberculosis for the secondarily highest rate with 20.2% （19/94）, blood type disseminated pulmonary tuberculosis with 9.6% （9/94）, intestinal tuberculosis with 14.9% （14/94）, tuberculosis pleuritis with 23.4% （22/94）, the extrapulmonary tuberculosis with 59.6%（56/94）. The positive rates for PPD, tuberculosis antibody, sputum anti-acid staining examination and sputum culture were low, and the positive rate for ESR and T-SPOT.TB was high, but only the differences of positive rates of tuberculosis antibody and ESR between them were statistically significant （P〈0.05）. Conclusion The manifestation and symptom of HIV/TB co-infection patients are not typical, but various co-examination can benefit the early diagnosis and treatment for patients with HIV/TB co-infection.