获得性免疫缺陷综合征合并分枝杆菌感染患者的免疫学特征与耐药性分析

Analysis of Immunological Characteristics and Drug Resistance in Patients with Acquired Immunodeficiency Syndrome Combined with Mycobacterial Infection

目的:分析获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)患者合并结核分枝杆菌(Mycobacterium tuberculosis,MTB)或非结核分枝杆菌(non-tuberculous mycobacteria,NTM)感染的免疫学特征及其对常用抗结核药物的耐药特点,为临床AIDS患者并发MTB或NTM感染的诊断和治疗提供参考。方法:选取2017年1月—2022年12月苏州市第五人民医院收治的44例AIDS合并MTB感染患者(设为AIDS/MTB感染组)和44例AIDS合并NTM感染患者(设为AIDS/NTB感染组)作为研究对象,采集患者的年龄、性别、免疫学检查结果,以及MTB和NTB对常用抗结核药物的药敏试验结果等信息,分析AIDS患者合并MTB或NTM感染的免疫学特征与耐药特点。结果:AIDS/MTB感染组和AIDS/NTB感染组患者的性别均以男性为主(93.18%vs97.73%),而年龄上均主要集中在30~<50岁(56.82%vs 59.09%),但2组患者在性别和年龄上的分布情况经比较其差异无统计学意义(P>0.05);AIDS/NTB感染组患者的T-SPOT检查均为阴性,AIDS/MTB感染组患者T-SPOT检查的阳性率较高;AIDS/MTB感染组患者的CD4^(+)T细胞绝对值明显高于AIDS/NTB感染组(108.4±76.7 vs36.5±22.1,P<0.05);AIDS/NTB感染组患者中检出的主要病原菌为鸟分枝杆菌和堪萨斯分枝杆菌,其对链霉素、异烟肼、利福平、乙胺丁醇、对氨基水杨酸、阿米卡星的耐药率均大于50.00%(远高于MTB对其的耐药率),仅对丙硫异烟胺的耐药率较低(<5.00%)。结论:AIDS患者并发MTB或NTM感染好发于30~<50岁的男性,T-SPOT检查和CD4^(+)T细胞水平可以较好地对MTB感染和NTM感染进行鉴别诊断;此外,NTM感染的病原菌对多数抗结核药物耐药性较强,应尽量选用其他敏感的抗菌药物进行治疗,以保证对患者的治疗效果。

Objective:To analyze the immunological characteristics of patients with acquired immunodeficiency syndrome(AIDS) combined with Mycobacterium tuberculosis(MTB) or non-tuberculous mycobacteria(NTM) infection and the characteristics of resistance to commonly used anti-tuberculosis drugs and provide reference for the clinical diagnosis and treatment of patients with AIDS combined with MTB or NTM infection.Methods:A total of 44 patients with AIDS combined with MTB infection(the AIDS/MTB infection group) and 44 patients with AIDS combined with NTM infection(the AIDS/NTB infection group) who were admitted to the Fifth People's Hospital of Suzhou from January2017 to December 2022 were chosen as the research subjects.The information such as patients' age,sex,immunological test results,and drug susceptibility test results of MTB and NTB to commonly used anti-tuberculosis drugs was collected to analyze the immunological characteristics and drug resistance characteristics of patients with AIDS combined with MTB or NTM infection.Results:The patients in both the AIDS/MTB infection group and the AIDS/NTB infection group were mainly males(93.18% vs 97.73%),and their ages were mainly in the range of 30 to less than 50 years(56.82% vs 59.09%),but upon comparation,there was no statistically significant difference in the sex and age distribution of patients between the two groups(P>0.05);the T-SPOT test results of patients in the AIDS/NTB infection group was negative,while the T-SPOT test results of patients in the AIDS/MTB infection group showed high positive rate;the absolute value of CD4^(+)T cells in the AIDS/MTB infection group was significantly higher than that in the AIDS/NTB infection group(108.4±76.7 vs 36.5±22.1,P<0.05);the main pathogenic bacteria detected in the AIDS/NTB infection group were Mycobacterium avium and Mycobacterium kansasii,whose resistance rates to streptomycin,isoniazid,rifampicin,ethambutol,para-aminosalicylic acid and amikacin were greater than 50.00%(much higher than the resistance rates of MTB to them),but resistance rate to prothionamide was low(less than 5.00%).Conclusion:Patients with AIDS combined with MTB or NTM infection are more likely to occur in men aged 30 to less than 50 years.The T-SPOT test and the CD4^(+)T cell levels can better differentiate MTB infection from NTM infection;in addition,the pathogenic bacteria of NTM infection are highly resistant to most anti-tuberculosis drugs.Other sensitive antibacterial drugs shall be used as much as possible to ensure the therapeutic effect on patients.