艾滋病合并结核感染的临床表现及病原学诊断特征

Clinical manifestations and pathogenic diagnosis of AIDS co-infected with tuberculosis

目的了解艾滋病合并结核感染的临床表现及病原学诊断特征,探讨提高HIV/AIDS患者合并结核感染诊断率的方法。方法选取2012年10月至2019年12月在湘西自治州人民医院确诊HIV/AIDS合并结核病的116例患者为观察组,另选取同期单纯性结核病初治患者59例为对照组。收集两组患者的临床症状、肺外结核、肺结核影像学特点、PPD结核菌素反应、样本夹层杯法抗酸染色结果、结核感染T细胞免疫斑点检测(T-SPOT.TB)结果、结核分支杆菌rpoB基因检测(XPERT)结果,并进行两组间比较。分析不同CD4+T细胞计数的观察组PPD和呼吸道样本(痰及灌洗液)夹层杯法抗酸染色的阳性率情况。结果观察组主要临床表现为反复中高热(82.76%)和体重下降(75.00%),肺外结核的发生率(56.89%)明显高于对照组(χ^(2)=10.911,P<0.05)。观察组的肺内病灶多侵犯2个甚至≥3个肺野(30.17%和46.55%),粟粒样改变多见(21.55%),均显著高于对照组(χ^(2)=7.160、7.310和4.709,P均<0.05)。观察组的常规PPD试验、呼吸道样本夹层杯抗酸染色检查以及初始T-SPOT.TB阳性率为14.66%、34.48%和46.67%,均明显低于对照组的40.68%、52.54%和82.35%(χ^(2)=14.763、5.290和10.471,P均<0.05);两组复核后的T-SPOT.TB及XPERT检测阳性率均较高,且差异无统计学意义(χ^(2)=1.857和0.405,P>0.05);肺外组织/穿刺液样本夹层杯法抗酸染色检查观察组阳性率达100.00%,高于对照组的66.67%(χ^(2)=12.291,P<0.05)。观察组患者中,CD4+T细胞计数越低,PPD阳性率和呼吸道样本夹层杯抗酸染色阳性率也越低。结论HIV/AIDS合并结核病患者的临床表现不典型,常规免疫学检查阳性率低;痰液和肺外样本的XPERT检测、改良的血液样本T-SPOT-TB检测、肺外组织和穿刺液的样本夹层杯法抗酸染色检查,均有助于艾滋病患者合并结核病的诊断。

Objective To understand the clinical manifestations and etiological diagnosis characteristics of AIDS patients complicated with tuberculosis,and to explore the method to improve the diagnosis rate of HIV/AIDS patients with tuberculosis.Methods There were 116 HIV/AIDS patients co-infected with tuberculosis enrolled as the observation group in People's Hospital of Xiangxi Autonomous Prefecture from October 2012 to December 2019,and 59 cases with simple tuberculosis in the same period were enrolled as the control group.The clinical symptoms,extrapulmonary tuberculosis,pulmonary tuberculosis imaging characteristics,PPD tuberculin response,sample mezzanine cup assay acid-fast staining results,tuberculosis infection T cellular immunospot detection(T-SPOT.TB)results,Mycobacterium tuberculosis rpoB gene detection(XPERT)results were collected and compared between the two groups.The positive rates of PPD and respiratory tract sample mezzanine cup acid-fast staining(sputum and bronchial lavage fluid)were further analyzed in the observation group with different CD4+T cell counts.Results The main clinical manifestations in the observation group were repeated high fever(82.76%)and weight loss(75.00%),and the incidence of extrapulmonary tuberculosis(56.89%)was significantly higher than that in the control group(χ^(2)=10.911,P<0.05).In the observation group,lung lesions were in 2 and≥3 lung fields(30.17%and 46.55%),and millet-like changes were common(21.55%),which were all significantly higher than those in the control group(χ^(2)=7.160,7.310 and 4.709,P<0.05).The positive rates of routine PPD test,respiratory tract sample mezzanine cup acid stain and the initial T-SPOT.TB in the observation group were 14.66%,34.48%and 46.67%,which were all significantly lower than 40.68%,52.54%and 82.35%in the control group(χ^(2)=14.763,5.290 and 10.471,P<0.05).The positive rates of T-SPOT.TB(after review)and XPERT were high in both groups,and there was no significant difference between them(χ^(2)=1.857 and 0.405,P>0.05).The positive rate of sample mezzanine cup acid-fast staining from extrapulmonary tissue and puncture fluid in the observation group was 100.00%,which was higher than 66.67%in the control group(χ^(2)=12.291,P<0.05).In the observation group,the lower the CD4+T cell count the lower the positive rates of PPD and sample mezzanine cup acid-fast staining in respiratory tract samples.Conclusions The clinical manifestations of HIV/AIDS patients co-infected with tuberculosis are atypical,and the positive rate of routine immunological examination is low.The XPERT testing of sputum and extrapulmonary specimens,the modified T-SPOT.TB test of blood,and sample mezzanine cup acid-fast staining of extrapulmonary tissue and puncture fluid are helpful to improve the diagnosis of AIDS patients complicated with tuberculosis.