艾滋病合并肺结核259例临床分析

Clinical analysis of 259 cases of AIDS complicated with pulmonary tuberculosis

目的分析艾滋病(AIDS)合并肺结核病人的临床特点,提高对艾滋病合并肺结核病人规范诊治的认识。方法回顾性分析2016年11月至2018年11月凉山州布拖县人民医院收治的259例艾滋病合并肺结核病人的临床资料。结果 259例艾滋病合并肺结核病人多为中青年男性,艾滋病病毒(HIV)感染主要经性接触传播(208例,80.3%)。常见临床表现为发热、咳嗽、咯痰(229例,88.4%),胸痛(83例,32.0%),腹泻(59例,22.8%),浅表淋巴结肿大(128例,49.4%),体重下降(165例,63.7%),鹅口疮(42例,16.2%)等。血常规主要是白细胞总数异常(142例,54.8%)和贫血(39例,15.1%)。血生化改变主要是转氨酶异常(24例,9.3%),合并丙型肝炎病毒抗体阳性率高(89例,34.4%)。CD4^+T淋巴细胞计数(<500个/μL)下降明显(196例,75.7%)。结论艾滋病合并肺结核病人临床表现多样且不典型,以呼吸系统及消化系统损害最常见。对于来自高流行区的病人,临床医师应高度警惕HIV感染可能,需尽早进行HIV抗体筛查明确诊断。

Objective To analyze the clinical characteristics of AIDS patients with pulmonary tuberculosis, and to improve the diagnosis and treatment. Methods The clinical data of 259 AIDS patients with pulmonary tuberculosis admitted in Lianshan Butuo People’s Hospital from Nov 2016 to Nov 2018 were retrospectively analyzed. Results Most of the 259 AIDS patients with pulmonary tuberculosis were young and middle-aged men, who were mainly transmitted through sexual contact(208, 80.3%). The common clinical manifestations included persistent or intermittent fever, recurrent cough, sputum(229, 88.4%), chest pain(83, 32.0%), diarrhea(59, 22.8%), superficial lymphadenopathy(128, 49.4%), weight loss(165, 63.7%), thrush(42, 16.2%), etc. Blood routine was highlighted for abnormal leukocyte count(142, 54.8%) and anaemia(39, 15.1%). The prominent changes of blood biochemistry were mainly abnormal transaminase(24, 9.3%) and high positive rate of hepatitis C antibody(89, 34.4%). The CD4^+T lymphocyte count( < 500 cells/μL) of AIDS patients with pulmonary tuberculosis significantly decreased(196, 75.7%), and immune function was severely damaged. Conclusion The clinical manifestations of AIDS patients with pulmonary tuberculosis are diverse and atypical, among which the respiratory and digestive systems are the most common. For patients from high-prevalence areas, clinicians should be highly alert to the possibility of HIV infection, and HIV antibody screening should be conducted as soon as possible for diagnosis.