HIV/AIDS儿童合并肺结核的临床特征与转归

Clinical characteristics and prognosis of pulmonary tuberculosis in children with HIV/AIDS

目的探讨人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)儿童合并肺结核的临床特征与转归。方法回顾性分析23例结核分枝杆菌培养阳性的AIDS合并肺结核患儿的临床资料,包括一般资料、实验室检查、影像学资料和疾病转归。结果23例患儿CD4^+T淋巴细胞<50个/mm^3占43.48%(10/23)。食欲下降、发热、咳嗽、乏力占比分别为86.95%、82.61%、82.61%、78.26%,可见如皮疹、关节肌肉僵硬和呕吐等不典型症状。影像学多表现为多部位和斑片状影占比分别为47.83%、43.48%。合并口腔黏膜白斑、带状疱疹和卡氏肺孢子肺炎各1例。19例患儿好转出院后定期随诊,2例无效或恶化,2例死亡。结论HIV/AIDS合并肺结核患儿临床表现缺乏特异性,全身性表现及肺外表现较重,影像学多表现为多部位和斑片状影,儿童HIV/AIDS早诊断、早治疗十分重要。

Objective To explore the clinical characteristics and prognosis of pulmonary tuberculosis in children with human immunodeficiency virus(HIV)/acquired immunedeficiency syndrome(AIDS).Methods A retrospective analysis was made on the clinical data of 23 children with HIV/AIDS and tuberculosis who were cultured positive for Mycobacterium tuberculosis,including general data,laboratory examinations,imaging data and disease outcomes.Results The percentage of CD4^+T lymphocytes<50/mm^3 was 43.48%(10≤23)in 23 children.The proportion of appetite loss,fever,cough and fatigue was 86.95%,82.61%,82.61%and 78.26%respectively.Atypical symptoms such as rash,joint muscle stiffness and vomiting could be seen.The proportion of multi-site and patchy shadow on chest radiography was 47.83%and 43.48%respectively.There were 1 case of oral mucosal leukoplakia,1 case of herpes zoster and 1 case of Pneumocystis carinii pneumonia.Nineteen children were followed up regularly after they were discharged from hospital.In 2 cases the treatments were ineffective or the diseases worsened,and two cases died.Conclusions The clinical manifestations of children with HIV/AIDS complicated with tuberculosis were lack of specificity.The general manifestations and extrapulmonary manifestations were serious.Chest imaging manifestations are mostly multi-site and patchy shadows.Early diagnosis and treatment of HIV/AIDS in children are very important.