艾滋病合并非结核分枝杆菌病患者的临床特征分析

Clinical characteristics of patients with acquired immunodeficiency syndrome complicated with nontuberculous mycobacteria disease

目的了解艾滋病合并非结核分枝杆菌(NTM)病的临床特征。方法回顾性分析复旦大学附属上海市公共卫生临床中心2019年1月1日至2021年12月31日诊断为艾滋病合并NTM病的190例患者的临床资料。根据是否为播散性NTM病分为艾滋病合并播散性NTM病组与艾滋病合并非播散性NTM病组。统计学分析采用独立样本t检验、曼-惠特尼U检验、χ2检验等。结果190例艾滋病合并NTM病患者中,男182例,女8例,年龄为(42±13)岁;首次住院天数为15(6,26)d;患者以合并肺孢子菌肺炎最常见,占12.1%(23/190);艾滋病合并播散性NTM病87例(45.8%)。患者临床症状以发热[55.8%(106/190)]、咳嗽[50.0%(95/190)]、咳痰[28.9%(55/190)]常见,艾滋病合并播散性NTM病组乏力[31.0%(27/87)比7.8%(8/103)]、纳差[21.8%(19/87)比10.7%(11/103)]比例高于非播散性NTM病组,差异均有统计学意义(χ2=16.99,P<0.001;χ2=4.42,P=0.036);艾滋病合并播散性NTM病组与非播散性NTM病组死亡患者比例差异无统计学意义[17.2%(15/87)比12.6%(13/103),χ2=0.80,P=0.371]。NTM菌种以鸟分枝杆菌最常见[67.1%(49/190)],其次为堪萨斯分枝杆菌[15.1%(11/190)]。播散性NTM病组的血红蛋白[(90.3±23.9)g/L比(110.1±24.2)g/L]、白蛋白[(29.7±5.5)g/L比(34.7±5.6)g/L]、CD4^(+)T淋巴细胞计数[11(5,30)/μL比52(16,96)/μL]、CD8^(+)T淋巴细胞计数[(362±320)/μL比(496±352)/μL]低于非播散性NTM病组(t=-5.63,P<0.001;t=-6.18,P<0.001;Z=-5.90,P<0.001;t=-2.73,P=0.007),降钙素原[0.24(0.10,0.77)μg/L比0.10(0.04,0.51)μg/L]高于非播散性NTM病组(Z=-3.09,P=0.002),差异均有统计学意义。影像学表现以肺斑片、条索影最常见[67.4%(128/190)]。结论艾滋病合并NTM病患者以播散性NTM病多见,菌种以鸟分枝杆菌最常见。艾滋病合并播散性NTM病和非播散性NTM病患者的临床表现(乏力、纳差)和实验室检查(血红蛋白、白蛋白、降钙素原、CD4^(+)T淋巴细胞计数、CD8^(+)T淋巴细胞计数)存在差异,预后无差异。

Objective To explore the clinical characteristics of acquired immunodeficiency syndrome(AIDS)complicated with nontuberculous mycobacteria(NTM)disease.Methods The clinical data of 190 patients with AIDS complicated with NTM disease diagnosed by Shanghai Public Health Clinical Center,Fudan University from January 1,2019 to December 31,2021 were analyzed retrospectively.NTM diseases were divided into disseminated NTM disease group and non-disseminated NTM disease group.The independent sample t test,Mann Whitney U test and chi-square test were used for statistical analysis.Results The 190 patients with AIDS complicated with NTM disease included 182 males and eight females.The age was(42±13)years old,and the first hospital stay was 15(6,26)days.Pneumocystis carinii pneumonia was the most common co-infection in 12.1%(23/190)of patients,87 cases(45.8%)were disseminated NTM disease.The clinical symptoms of patients were common in fever(55.8%(106/190)),cough(50.0%(95/190)),and expectoration(28.9%(55/190)).The proportions of fatigue(31.0%(27/87)vs 7.8%(8/103)),poor appetite(21.8%(19/87)vs 10.7%(11/103))in the AIDS patients with disseminated NTM disease group were higher than those in the non-disseminated NTM disease group,and the differences were statistically significant(χ2=16.99,P<0.001 andχ2=4.42,P=0.036,respectively).There was no significant difference in the proportions of deaths between AIDS patients with disseminated NTM disease and those without disseminated NTM disease(17.2%(15/87)vs 12.6%(13/103),χ2=0.80,P=0.371).The most common NTM species was Mycobacterium avium(67.1%(49/190)),followed by Mycobacterium kansasii(15.1%(11/190)).Hemoglobin((90.3±23.9)g/L vs(110.1±24.2)g/L),albumin((29.7±5.5)g/L vs(34.7±5.6)g/L),CD4^(+)T lymphocyte count(11(5,30)/μL vs 52(16,96)/μL)and CD8^(+)T lymphocyte count((362±320)/μL vs(496±352)/μL)in the disseminated NTM disease group were lower than those in non-disseminated NTM disease group(t=-5.63,P<0.001;t=-6.18,P<0.001;Z=-5.90,P<0.001;and t=-2.73,P=0.007,respectively),while procalcitonin(0.24(0.10,0.77)μg/L vs 0.10(0.04,0.51)μg/L)was higher than that in the non-disseminated NTM disease group(Z=-3.09,P=0.002),with statistical significance.The most common imaging features were lung patch and strip shadow(67.4%(128/190)).Conclusions The most common type of AIDS patients complicated with NTM disease is disseminated NTM disease,and Mycobacterium avium is the most common NTM species.The clinical manifestations(fatigue,anorexia)and laboratory tests(hemoglobin,albumin,procalcitonin,CD4^(+)T lymphocyte count,CD8^(+)T lymphocyte count)of AIDS patients with disseminated NTM disease and non-disseminated NTM disease are different,while the prognosis is not significantly different.