摘要
目的 探索广西壮族自治区HIV与MTB双重感染患者的临床特征,为进一步研究双重感染的控制、诊疗提供科学依据.方法 连续纳入2013年9月至2015年8月广西壮族自治区南宁市、来宾市和贵港市可随访的HIV感染者或AIDS患者,且发现HIV感染后无结核病诊断史及抗结核药物使用史;同时纳入性别、年龄（±3岁）相近的单纯结核病患者,均采用统一设计的调查表调查.通过临床特征分析及相关实验室检查对双重感染患者、单纯HIV感染者或AIDS患者、单纯结核病患者进行比较分析.结果 共纳入HIV感染者或AIDS患者1024例,确诊或临床诊断并发MTB感染者160例（15.62％）（简称“双重感染组”）;单纯HIV感染者或AIDS患者505例（49.32％）.纳入单纯结核病患者489例.双重感染组在咳嗽咯痰[76.88％（123/160）]、符合结核病的胸部影像学改变[80.00％（128/160）]、痰涂片阳性率[7.32％（9/123）]均低于单纯结核病组[93.46％（457/489）、98.98％（484/489）、34.97％（171/489）]（χ^2分别为34.88,80.76,36.20,P值均＜0.01）,而低热[41.25％（66/160）]、体质量下降[34.38％（55/160）]、盗汗[8.75％（14/160）]、肺外结核[22.50％（36/160）]的发生率均高于单纯结核病组[8.79％（43/489）、6.34％（31/489）、3.89％（19/489）、0.41％ （2/489）]（χ^2=90.88,P＜0.01;χ^2=82.43,P＜0.01;χ^2=5.91,P=0.015;χ^2=106.73,P＜0.01）.双重感染组患者体质量下降[34.38％（55/160）]、气促和（或）呼吸困难[21.88％（35/160）]、胸痛[10.00％（16/160）]、腹泻数天不止[9.38％（15/160）]、舌表面鹅口疮或口腔黏膜奶酪样白斑[27.50％（44/160）]等临床表现发生率均高于单纯HIV感染者或AIDS患者[6.14％（31/505）、3.17％（16/505）、0.59％（3/505）、2.18％（11/505）、5.35％（27/505）]（χ^2分别为86.04,60.05,Fisher精确检验,16.75,62.53,P值均＜0.01）.CD4＋T淋巴细胞计数（74.00个/mm3）明显低于单纯HIV感染者和（或）AIDS患者（282.00个/mm3）（Z=-9.43,P＜0.01）.双重感染组未接受艾滋病抗病毒药物治疗（HAART）者咳嗽咯痰[81.36％（96/118）]、低热[50.00％（59/118）]、体质量减轻[41.53％（49/118）]的发生率明显高于接受治疗者[64.29％（27/42）、16.67％（7/42）、9.52％ （4/42）]（χ^2=5.08,P=0.024;χ^2=14.20,P＜0.01;χ^2=14.32,P＜0.01）;而有无卡介苗接种史[62.86％（22/35）、84.80％（106/125）]的差异仅在与结核病相符的影像学改变方面有统计学意义（χ^2 =8.23,P＜0.01）.结论 双重感染患者临床特征复杂,诊断难度大,需对其加强监测和随访,并探索和推广新快速诊断方法,以及早发现、进行治疗.
Objective To explore the clinical features of HIV/MTB co-infected patients in Guangxi Zhuang Autonomous Region （or Guangxi）,and to provide scientific basis for further researches on the control,diagnosis and treatment of HIV/MTB co-infection.Methods HIV/AIDS patients who were followed up without previous diagnosis and treatment of TB were continuously enrolled in Nanning,Laibin and Guigang of Guangxi from September,2013 to August,2015.Simultaneously,TB patients were enrolled with same genders and similar ages （± 3 years）.Standardized questionnaire was designed and used to collect the information.The clinical features and laboratory exam results were compared among HIV/MTB cases,HIV/AIDS cases and TB cases.Results Among 1024 enrolled cases infected with HIV,160 （15.62%） were confirmed/clinical diagnosed HIV/MTB cases,505 （49.32%） were HIV infection/AIDS patients.And 489 TB cases were enrolled.Less HIV/MTB cases had cough/ expectoration （76.88% （123/160））,suggestive radiological findings （80.00% （128/160）） and sputum smear positivity （7.32% （9/123））,when compared with cases of TB （93.46% （457/489）,98.98% （484/489）,34.97% （171/489）） （χ^2=34.88,80.76,36.20,all P〈0.01）,while the incidences of fever （41.25% （66/160））,weight loss （34.38% （55/160））,night sweat （8.75% （14/160）） and extrapulmonary TB （22.50% （36/160）） were more than TB cases （8.79% （43/489）,6.34% （31/489）,3.89% （19/489）,0.41% （2/489））,which were significantly different （χ^2 =90.88,P〈0.01;χ^2=82.43,P〈0.01;χ^2=5.91,P=0.015;χ^2-106.73,P〈0.01）.In HIV/MTB cases group,weight loss （34.38% （55/160））,anhelation （21.88% （35/160））,pectoralgia （10.00% （16/160））,lasting diarrhea （9.38% （15/160））,oral thrush or mucous leukoplakia （27.50% （44/160）） were more common when comparing with the HIV/AIDS cases （6.14% （31/505）,3.17% （16/505）,0.59% （3/505）,2.18% （11/505）,5.35% （27/505）） （χ^2=86.04,60.05,Fisher＆#39;s exact test,16.75,62.53,all P〈0.01）.The median count of CD4-T cell in HIV/MTB cases （74.00/rnm3） was lower than HIV/AIDS cases （282.00/mm3）（Z=-9.43,P〈0.01）.When comparing the HIV/MTB cases who had not undergone HAART with those had undergone HAART,the former manifested more frequency of cough/expectoration （81.36% （96/118） vs.64.29%（27/42））,fever （50.00% （59/118） vs.16.67% （7/42）） and weight loss （（41.53% （49/118） vs.9.52%（4/42）） （χ^2 =5.08,P=0.024;χ^2 =14.20,P〈0.01;χ^2 =14.32,P〈0.01）.Patients vaccinated BCG or not had significant difference only in suggestive radiological findings （62.86% （22/35） vs.84.80% （106/125）） （χ^2 =8.23,P〈0.01）.Conclusion HIV/MTB cases have more complex clinical features,resulting in more difficulty in diagnosis.Monitoring and follow-up should be strengthened,and new rapid diagnostic tests are needed to be explored and promoted for early identification and treatment of HIV/MTB patients.
作者
梁大斌
林玫
蓝如束
崔哲哲
覃慧芳
林定文
谢志满
蒋权
韦柏才
LIANG Da-bin LIN Mei LAN Ru-shu CUI Zhe-zhe QIN Hui-fang LIN Ding-wen XIE Zhi-man JIANG Quan WEI Bo-cai(Institute of Tuberculosis Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning 530028, Chin)
出处
《中国防痨杂志》
CAS
2017年第7期717-722,共6页
Chinese Journal of Antituberculosis
基金
广西医疗卫生适宜技术研究与开发课题（S201310-04）
关键词
HIV感染
获得性免疫缺陷综合征
分枝杆菌
结核
重叠感染
疾病特征
HIV infections
Acquired immunodeficiency syndrome
Mycobacterium tuberculosis
Super-infection
Disease attributes
作者简介
通信作者：林玫，Email：gxlinmei@126．com
