艾滋病合并肺结核30例临床特点及危险因素分析

Clinical Characteristics and Analysis of Risk Factors on 30 AIDS Patients Complicated with Pulmonary Tuberculosis

目的:分析艾滋病合并肺结核患者的临床特点及危险因素。方法:回顾性选取2018年7月-2020年10月秦皇岛市第三医院收治的艾滋病合并肺结核患者30例作为观察组,同期收治单纯艾滋病患者85例作为对照组,比较两组的临床特点,分析艾滋病患者合并肺结核的危险因素。结果:6例(20.00%)先确诊肺结核后查出HIV感染,24例(80.00%)为先确诊HIV感染后查出肺结核,临床表现低热22例(73.33%)、盗汗16例(53.33%)、咳嗽18例(60.00%)最为多见,此外还有消瘦、痰中带血,10例(33.33%)痰涂片找到抗酸杆菌,20例(66.67%)PPD试验阳性,15例(50.00%)痰培养抗酸杆菌阳性,12例(40.00%)结核感染T细胞检测(T-SPOT.TB)阳性,CT检查示粟粒性肺结核2例(6.67%),继发性肺结核28例(93.33%),合并结核性胸膜炎10例(33.33%),合并胸腔积液12例(40.00%)。经多因素Logistic回归分析结果得出吸烟、低家庭年收入、无业、低体重、低CD4^(+)T细胞计数是艾滋病患者合并肺结核感染的独立危险因素,而接种卡介苗是保护因素。结论:艾滋病合并肺结核临床症状表现复杂,尤其是CD4^(+)T淋巴细胞计数小于200个/μl增加了肺结核发病率,在临床应注意高效抗逆转录病毒(HAART)的时机,以及抗结核、抗病毒之间的相互影响,选择个体化治疗方案。吸烟、低收入、无业、低体重、低CD4^(+)细胞计数为艾滋病患者合并肺结核的独立危险因素,接种卡介苗为艾滋病患者合并肺结核感染的保护因素。

Objective:To analyze the clinical characteristics and risk factors of AIDS patients complicated with pulmonary tuberculosis.Method:Thirty AIDS patients complicated with tuberculosis admitted to the Third Hospital of Qinhuangdao from July 2018 to October 2020 were retrospectively selected as the observation group,and 85 patients with simple AIDS admitted during the same period were retrospectively selected as the control group.The clinical characteristics of the two groups were compared,and the risk factors of AIDS patients complicated with pulmonary tuberculosis were analyzed.Result:Six cases(20.00%)were diagnosed with pulmonary tuberculosis first and then HIV infection was detected,24 cases(80.00%)were diagnosed with HIV infection first and then pulmonary tuberculosis was diagnosed.The clinical manifestations were 22 cases(73.33%)with low fever and 16 cases(53.33%)with night sweats,cough was the most common in 18 cases(60.00%),in addition weight loss and blood in sputum;10 cases(33.33%)found acid-fast bacilli on sputum smears,20 cases(66.67%)were positive in PPD test,and 15 cases(50.00%)were positive in acid-fast bacilli in sputum culture,12 cases(40.00%)were positive in detection of T cells infected with tuberculosis(T-SPOT.TB);CT examination showed 2 cases(6.67%)of miliary tuberculosis,28 cases(93.33%)of secondary tuberculosis,10 cases(33.33%)of tuberculous pleurisy,12 cases(40.00%)of pleural effusion.The results of multivariate Logistic regression analysis showed that smoking,low home income yearly,unemployed,low weight,and low CD4^(+)T cell count were independent risk factors for AIDS complicated with pulmonary tuberculosis infection,and BCG vaccination was protective factor.Conclusion:The clinical symptoms of AIDS complicated with tuberculosis are complex,especially the CD4^(+)T lymphocyte count less than 200/μl increases the incidence of tuberculosis.In clinical practice,attention should be paid to the timing of highly active anti-retroviral therapy(HAART),and interaction effect between anti-tuberculosis and antiviral,choose individualized treatment plan.Smoking,low home income yearly,unemployed,low weight,and low CD4^(+)T cell count were independent risk factors of AIDS patients complicated with pulmonary tuberculosis,BCG vaccination is protective factor for AIDS patients complicated with pulmonary tuberculosis.