HIV/AIDS患者结核病的预防和治疗研究

Research on tuberculosis prevention and treatment in HIV/AIDS patients.

目的 调查艾滋病病毒 (HIV) /艾滋病 (AIDS)患者结核菌素纯蛋白衍化物 (PPD)试验反应状况及与免疫系统受损程度的联系 ,并探讨其在HIV/AIDS患者中结核病 (TB)预防和治疗研究的意义。方法 采用前瞻性病例对照研究方法 ,对 2 0 2例健康者及 5 5例经蛋白印迹试验 (WB)确证的HIV感染者和AIDS病人做PPD试验 ,CD4、CD8淋巴细胞计数及分组服药 ,对照观察胸部病变情况。结果 HIV/AIDS患者PPD试验阳性率为 10 0 % ,健康者PPD试验阳性率 2 8 2 % ,差异有非常显著的统计学意义 (χ2 =7 17,P <0 0 1)。 13例CD4细胞计数 <2 0 0 /mm3 的HIV/AIDS病例 ,PPD试验均无反应 (0× 0mm)。当CD4细胞计数升高时 ,其PPD试验反应增强。病例服药组经化学药物预防治疗后 ,其肺部病变异常率为 30 8% ,低于病例对照组的异常率 4 1 7%。结论 HIV/AIDS患者PPD试验阳性率非常显著地低于健康人。对HIV/AIDS患者使用化学药物预防和治疗TB是有效的 。

Objective To investigate the association between immune deficiency and tuberculin positive response and its implication for tuberculosis prevention and treatment in HIV/AIDS patients.Methods The prospective study was applied.Fifty five HIV/AIDS patients confirmed by western blot and 202 healthy individuals were observed.Tuberculin test,CD 4 and CD 8 cell counts as well as chest X-ray or pulmonary conditions were examined in the two groups.Results Ten percent of HIV/AIDS patients were PPD positive,while 28.2% of healthy individuals were PPD positive(P<0.01).Thirteen HIV/AIDS patients with CD 4 cell<200 were PPD negative(0×0mm).PPD reaction increased with the increase in CD 4 cell count.The abnormality rate of pulmonary conditions was less in the therapy group(30.8%)than in the control group(41.7%).Conclusion PPD reaction in HIV/AIDS patients was significantly lower than in healthy individuals.Chemotherapy was effective for prevention and treatment of tuberculosis in HIV/AIDS patients.This kind of knowledge is providing useful evidence for policy making.