艾滋病合并肺结核患者的临床特点与诊治分析

Diagnosis and treatment of AIDS patients with pulmonary tuberculosis and their clinical features

目的提高艾滋病合并肺结核的诊断水平,采取积极有效的治疗措施并分析总结诊治特点。方法回顾性分析2012年7月至2019年6月本院艾滋病合并肺结核患者80例临床表现特点,实验室检查及影像学检查特征,分析总结诊断要点和治疗重点及注意事项。结果26例(32.5%)为先确诊HIV感染后查出肺结核,54例(67.5%)先确诊肺结核而后检出HIV感染;临床症状以咳嗽最为多见,常见还有发热、消瘦和盗汗;70例痰找抗酸杆菌阳性(87.5%),36例PPD皮试阳性(45.0%),32例痰培养抗酸杆菌阳性(40.0%);CT检查示粟粒性肺结核8例(10.0%),51例继发型肺结核(63.7%),20例合并结核性胸膜炎(25.0%),18例合并胸腔积液(22.5%);予EHRZO或EHRZS方案抗结核治疗,70例痰菌阳性患者中有41例经抗结核2周后痰找抗酸杆菌阴转,占58.6%;74例患者复查CT肺部结核病灶有好转(92.5%)。结论艾滋病合并肺结核病情复杂,临床应重视提高本病的诊断水平,做到早发现、早隔离、早治疗;本病易合并多器官损害,需注意个体化治疗的特点。

Objective To analyze and study the diagnosis and treatment of AIDS patients with pulmonary tuberculosis,and to improve the diagnosis and treatment level.Methods The clinical manifestations and features of laboratory examination and iconography from in AIDS patients with pulmonary tuberculosis treated at our hospital from July,2012 to June,2019 were retrospectively analyzed;the key points of diagnosis and treatment were analyzed.Results 26 cases(32.5%)were diagnosed with pulmonary tuberculosis after HIV infection,but pulmonary tuberculosis were diagnosed first in 54 cases(67.5%).Cough was the the most common symptom,and fever,emaciatedness,and night sweat were frequent.The sputum smear for acid fast bacilli were detected in 70 cases(87.5%),PPD were positive in 36 case(45.0%),and the sputum culture for acid fast bacilli were positive in 32 cases(40.0%).CT examination showed that 8 cases(10.0%)got phthisis miliaris,51(63.7%)secondary pulmonary tuberculosis,20(25.0%)tuberculous pleurisy,and 18(22.5%)pleural effusion.Sputum tubercle bacillus was negative in 41 cases(58.6%)and 74 cases(92.5%)were improve in CT after 2 weeks’EHRZO or EHRZS therapies.Conclusions AIDS patients with pulmonary tuberculosis have complicated conditions.The early diagnosis,isolation and therapy are important.The therapy should be individualized,because of multiple organ damage.