肺结核合并艾滋病患者临床及预后分析

Clinical features and prognosis of tuberculosis patients with AIDS

目的探讨合并艾滋病对肺结核患者临床症状、实验室检查结果、影像学特征及预后的影响。方法选取2011年5月至2016年8月确诊的37例HIV合并肺结核感染者和59例单纯肺结核患者为研究对象。收集患者疾病相关临床症状、实验室检查及影像学检查结果,采用多因素Cox回归分析探讨肺结核患者预后的影响因素。结果HIV-肺结核组与肺结核组咳嗽、咳痰、腹泻等症状差异无统计学意义(P>0.05);但是合并艾滋病感染组患者出现发热、咯血、夜间盗汗、呼吸困难及体重减轻等症状的概率显著高于肺结核组患者(P<0.05,P<0.01)。HIV-肺结核组患者血液中CD4^+T细胞数量显著低于肺结核组(P<0.05)。HIV-肺结核组患者粟粒结节影、肺外结核、累及两个以上肺段、纵隔淋巴结肿大4种影像学特征指标比例显著高于肺结核组(P<0.05);而HIV-肺结核组患者空洞发生率显著低于肺结核组(P<0.05)。HIV确诊年龄≥40岁、非性传播途径、CD4^+T细胞数(/mm^3)<200个及未接受抗病毒治疗是合并艾滋病肺结核患者预后的独立危险因素(P<0.05)。结论合并艾滋病感染会使肺结核患者发热、咯血等临床症状加重,CD4^+T细胞数量降低,肺部病变加重,从而影响肺结核患者的预后情况。

Objective To explore the influences of co-infected acquired immune deficiency syndrome(AIDS)on clinical symptoms,laboratory examination results,imaging features and prognosis of patients with pulmonary tuberculosis(PTB).Methods From May 2011 to August 2016,37 PTB patients with confirmed human immunodeficiency virus(HIV)(HIV-PTB group)and 59 patients with simple PTB(PTB group)were selected.After collecting the disease-related clinical symptoms,laboratory examination and imaging examination results,the prognostic factors of PTB patients were explored by multivariate cox regression analysis.Results Complicated HIV infection had no significant effect on cough,sputum,diarrhea and other symptoms in PTB patients(P>0.05),but the incidences of fever,hemoptysis,night sweats,dyspnea and weight loss in HIV-PTB group were significantly higher than those in PTB group(P<0.05,P<0.01).Compared with PTB group,the number of CD4^+T cells significantly decreased,and the proportions of miliary nodule shadow,extrapulmonary tuberculosis,involvement of more than two lung segments and mediastinal lymph node enlargement significantly increased in HIV-PTB group(all P<0.05).However,the incidence of TB cavity formation in HIV-PTB group was significantly lower than that in TB group(P<0.05).The age of more than 40 years old at HIV diagnosis,non-sexual transmission of HIV,CD4^+T cell number[(/mm^3)<200]and no antiviral treatment were the independent risk factors for the prognosis of PTB patients with AIDS(P<0.05).Conclusion Co-infected AIDS in PTB patients will aggravate the clinical symptoms such as fever and hemoptysis,worsen the degree of lung lesions and reduce the number of CD4^+T cells,thus affecting the prognosis of the patients.