单纯肺结核患者与艾滋病合并肺结核患者的临床特征与实验室检测结果对比分析

Comparative analysis of clinical characteristics and laboratory test results between patients with tuberculosis alone and those with AIDS combined with tuberculosis

目的 分析艾滋病合并肺结核患者临床特征,评估不同检测方法(病原学、免疫学、分子生物学)在结核病诊断中的运用。方法 选取2020年1月至2021年12月云南省传染病医院收治的130例艾滋病合并肺结核患者(AIDS-TB组)及146例单纯肺结核患者(TB组),分析2组病例的临床资料及结核杆菌病原学、免疫学、分子生物学检查结果。采用SPSS21.0软件进行统计分析,计量资料采用x±s表示,计数资料采用百分率表示,组间比较采用χ^(2)检验,非正态分布数据选用秩和检验,以P<0.05表示差异有统计学意义。结果 AIDS-TB组发热、消瘦症状发生率高于TB组,而咳嗽、咳痰症状低于TB组;TB组患者咳嗽时长大于8周者高于AIDS-TB组,而发热体温大于39℃的人数低于AIDS-TB组,上述差异均有统计学意义(P均<0.05)。TB组中T-SPOT、痰涂片、Gene Xpert MTB/RIF检测阳性率均高于AIDS-TB组(P均<0.05)。2组均以Gene Xpert MTB/RIF检测阳性率最高,且与痰涂片、T-SPOT检测阳性率差异均有统计学意义(P均<0.05)。2组患者CD_(4)^(+)/CD_(8)^(+)比值差异有统计学意义(P<0.001),AIDS-TB组CD_(4)^(+)/CD_(8)^(+)比值出现倒置,而TB组CD_(4)^(+)/CD_(8)^(+)比值在正常范围。AIDS-TB组3种检测结果的阳性率随CD_(4)^(+)T淋巴细胞计数下降而减低,但差异无统计学意义。结论 艾滋病合并肺结核患者临床症状不典型,虽然其病原学及免疫学阳性率低于单纯结核病患者,但Gene Xpert MTB/RIF检测仍是诊断结核病的重要手段。

Objective To analyze the clinical characteristics of tuberculosis in patients with AIDS and to evaluate the diagnostic utility of different detection methods,including etiology,immunology,and molecular biology.Methods A total of 130 patients with AIDS combined with tuberculosis(AIDS-TB group)and 146 patients with uncomplicated tuberculosis(TB group)who were admitted to Yunnan Provincial Infectious Disease Hospital from January 2020 to December 2021 were included in this study.The clinical data,as well as the etiology,immunology,and molecular biology results of tuberculosis bacilli in both groups were analyzed.Statistical analysis was performed by using SPSS 21.0 software.Measurement data were presented as x±s,counting data were expressed as percentage.Comparison between groups was conducted by using theχ^(2) test,and non-normal distribution data were assessed by using the rank sum test.The differernce P<0.05 was considered statistically significant.Results The incidence of fever and wasting was higher in the AIDS-TB group compared to the TB group,while cough and sputum symptoms were lower in the former.The number of patients with cough duration more than 8 weeks was higher in the TB group,whereas patients with fever temperature greater than 39℃were fewer in the AIDS-TB group.These differences were statistically significant(all P<0.05).Positive rates for T-SPOT,sputum smear,and Gene Xpert MTB/RIF were higher in the TB group compared to those in the AIDS-TB group(all P<0.05).Gene Xpert MTB/RIF had a significantly higher positive rate than sputum smear and T-SPOT tests(all P<0.05)across both groups.There was a statistically significant difference between CD_(4)^(+)/CD_(8)^(+)among both groups(P<0.001),CD_(4)^(+)/CD_(8)^(+)ratio was inverted for AIDS-TB but within normal range for TB cases.In AIDS-TB cases,positive test results decreased as CD_(4)^(+)T lymphocyte count decreased.However,there was no statistical difference.Conclusions AIDS patients with tuberculosis clinical symptoms were not typical.Although the positive rate of etiology and immunology was lower than that of patients with simple tuberculosis,Gene Xpert MTB/RIF detection was still an important means to diagnose tuberculosis.