艾滋病合并肺结核患者的临床特点与诊治分析

Clinical Characteristics,Diagnosis and Treatment of AIDS Patients With Pulmonary Tuberculosis

目的探讨艾滋病合并肺结核患者的临床特点与诊治分析。方法选取2018年4月—2020年4月医院收治且经诊断后确诊为艾滋病合并肺结核患者40例作为观察组,并将同期单纯肺结核患者40例作为对照组,观察两组患者临床特点,并根据其临床特点进行诊治分析。结果观察组患者体质量减轻、发热以及腹泻等临床症状发生率较对照组更高,痰中带血、盗汗以及咳嗽等临床症状发生率较对照组更低,差异有统计学意义(P<0.05),两组患者咯痰发生率相较无明显差异,差异无统计学意义(P>0.05);观察组患者结合菌素试验(purified protein derivative,PPD)(+)、痰涂片抗菌染色(+)占比均较对照组更低,差异有统计学意义(P<0.05),两组患者痰结核分歧杆菌培养(+)占比相较无明显差异,差异无统计学意义(P>0.05);两组患者经胸部CT检查,影像学表现检出的各临床症状检出率做比对,观察组更高,差异有统计学意义(P<0.05);观察组患者检出合并空洞率较对照组更低,差异有统计学意义(P<0.05);观察组患者肺叶尖段、后段有斑片状阴影,肺上叶存在大片状实质性变影,弥漫性栗粒样结节,并且分布情况及结节表现形态均不明显,肺部存在多发大小不一的空洞影,周围存在明显渗出灶。结论艾滋病合并肺结核患者临床检查过程中并不存在特异性症状表现,相对单纯肺结核患者而言,PPD阳性率以及抗菌染色阳性率会更低,其影像学表现则是肺部存在多肺叶、多肺段渗出病变的的情况,在对艾滋病合并肺结核和单纯肺结核两种疾病的诊断中应注意区分,才能为患者制定有效的治疗方案。

Objective To investigate the clinical characteristics,diagnosis and treatment of AIDS patients with pulmonary tuberculosis.Methods From April 2018 to April 2020,40 patients with AIDS complicated with pulmonary tuberculosis were selected as the observation group,and 40 patients with simple pulmonary tuberculosis in the same period were selected as the control group.The clinical characteristics of the two groups of patients were observed,and the diagnosis and treatment were analyzed according to their clinical characteristics.Results The incidence of clinical symptoms such as weight loss,fever and diarrhea in the observation group was higher than that in the control group,and the incidence of blood in sputum,night sweat and cough was lower than that in the control group,the difference was statistically significant(P<0.05),the incidence of expectoration between the two groups had no significant difference,and the difference was not statistically significant(P>0.05).The proportions of purified protein derivative(PPD)test(+)and antibacterial staining of sputum smear(+)in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the proportion of mycobacterium tuberculosis(+)culture in sputum,and the difference was not statistically significant(P>0.05);the detection rate of each clinical symptom detected by chest CT examination and imaging findings of the two groups of patients was compared,and the observation group was higher,and the difference was statistically significant(P<0.05);the observation group had lower detection rate of cavities than the control group,and the difference was statistically significant(P<0.05);in the observation group,there were patchy shadows in the apical and posterior segments of the lung lobes,and there were large patches of solid shadows in the upper lobe of the lungs,with diffuse mitral-like nodules,and the distribution and nodules were not obvious.There were multiple cavitary shadows of different sizes,and there were obvious exudative foci around them.Conclusion There are no specific symptoms in the clinical examination of AIDS patients with pulmonary tuberculosis,and the positive rate of PPD and acid fast staining is lower than that of patients with simple pulmonary tuberculosis.The imaging manifestations are the presence of multilobe and multi-segment exudative lesions in the lungs.The imaging manifestations of patients with AIDS complicated with pulmonary tuberculosis and simple pulmonary tuberculosis should pay attention in order to make effective treatment plan for patients.