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

doi:10.19871/j.cnki.xfcrbzz.2023.02.009

摘要/Abstract

摘要： 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。

关键词: 人类免疫缺陷病毒, 获得性免疫缺陷综合征, 肺结核, 诊断延迟, 临床特点

Abstract: 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.

Key words: Human immunodeficiency virus, Acquired immunodeficiency syndrome, Tuberculosis, Delayed of diagnosis, Clinical features

中图分类号:

R512.91

杨红红, 曾琴, 吴玉珊, 刘倩, 李明俊, 刘敏, 苏世芳. 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[J]. 新发传染病电子杂志, 2023, 8(2): 45-48.

Yang Honghong, Zeng Qin, Wu Yushan, Liu Qian, Li Mingjun, Liu Min, Su Shifang. Clinical characteristics of 287 cases of HIV/AIDS with sputum-negative and sputum-positive pulmonary tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(2): 45-48.

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