287例HIV感染/AIDS合并初治菌阴与菌阳肺结核的临床特点分析

Clinical characteristics of 287 cases of HIV/AIDS with sputum-negative and sputum-positive pulmonary tuberculosis

目的分析HIV感染/AIDS患者合并初治菌阴与菌阳肺结核的临床表现特点。方法收集HIV感染/AIDS合并初治菌阴肺结核99例及菌阳肺结核188例的临床资料进行回顾性分析。结果HIV感染/AIDS合并菌阳肺结核组(菌阳组)的首诊延迟率、诊断延迟率(68.1%,88.8%)明显高于HIV感染/AIDS合并菌阴肺结核组(菌阴组)(48.5%、83.8%),且首诊延迟率差异有统计学意义(P<0.05);菌阴组的卫生系统延迟率(56.6%)高于菌阳组(44.7%),差异无统计学意义(P>0.05)。菌阳组咳嗽、体重下降明显高于菌阴组,差异有统计学意义(P<0.05)。菌阳组3个肺野以上受累率(53.7%)明显高于菌阴组(40.4%),差异有统计学意义(P<0.05)。菌阳组血红蛋白及白蛋白下降率(72.9%、85.1%)均较菌阴组(65.6%、74.7%)明显,白蛋白下降率差异有统计学意义(P<0.05)。菌阴组合并肺外结核的发生率(67.7%)高于菌阳组(51.1%),且菌阴组结核性脑膜炎占比(26.3%)亦明显高于菌阳组(11.2%),差异均有统计学意义(P<0.05)。结论AIDS合并菌阳、菌阴肺结核均存在明显的诊断延迟;HIV感染/AIDS患者胸部影像学及血液指标明显异常时,特别是营养不良及低蛋白血症患者,需加强痰液结核相关的检查。AIDS合并菌阴肺结核患者的肺外结核及结核性脑膜炎的发生率高,需加强HIV感染/AIDS患者肺外结核的筛查。

Objective To analyze the clinical characteristics of HIV/AIDS patients with sputum-negative and sputum-positive pulmonary tuberculosis.Method The clinical data of 99 patients with sputum-negative pulmonary tuberculosis and 188 HIV/AIDS patients with sputum-positive pulmonary tuberculosis were collected and retrospectively analyzed.Result The incidence rates of delay in first seeking care and delay in diagnosis were 68.1%and 88.8%in the sputum-positive group,respectively,which were higher than those of in the sputum-negative group(48.5%and 83.8%);the difference in delay in first seeking care was significant(P<0.05).The delay in diagnosis(health system delay)in the sputum-negative group was greater than that in the sputum-positive group,but the difference was not statistically significant(P>0.05).The sputum-positive group had significantly greater rates of cough and weight loss than the sputum-negative group(P<0.05).In the positive-group,patients with more than 3 lung fields involved accounted for 53.7%,a significantly higher proportion than that in the sputum-negative group(40.4%)(P<0.05).The incidence rates of hypochromica and hypoproteinemia were 72.9%and 85.1%in the sputum-positive group;these rates were higher than those in the sputum-negative group(65.6%and 74.7%).The incidence rates of extrapulmonary tuberculosis and tuberculous meningitis in the sputum-negative group(67.7%and 26.3%)were significantly higher than those in the sputum-positive group(51.1%and 11.2%)(P<0.05).Conclusion There were diagnostic delays in both the sputum-positive group and the sputum-negative group.The sputum examination of tuberculosis should be improved in HIV/AIDS patients when chest imaging or blood indicators are abnormal,especially in patients with malnutrition and hypoproteinemia.The incidence rates of extrapulmonary tuberculosis and tuberculous meningitis were high in HIV/AIDS patients in the sputum-negative group.Screening for extrapulmonary tuberculosis in HIV/AIDS patients should be improved.