AIDS合并播散性非结核分枝杆菌病的临床特征与死亡危险因素分析

发布时间：2018-04-16 20:26

本文选题：艾滋病 + 播散性非结核分枝杆菌病　；参考：《中国艾滋病性病》2017年11期

【摘要】：目的了解艾滋病(AIDS)合并播散性非结核分枝杆菌病(DNTM)的临床、病原学特点及治疗转归,提高该病诊疗水平。方法回顾性分析30例血培养确定AIDS合并DNTM患者的临床资料,比较存活与死亡患者的差异。结果 30例患者男性26例,女性4例,平均年龄(35.5±7.8)岁。主要临床表现:发热(28例)、咳嗽(23例)、咳痰(17例)、午后发热(16例)等。CD4+T淋巴细胞中位数5个/μL(0~63个/μL)、血沉升高25例、贫血26例、白细胞降低12例、白细胞升高5例、血小板减少7例。30例患者均出现不同程度胸腹部CT影像学异常,主要包括:肝肿大(21例)、脾肿大(24例)、胸腔淋巴结肿大(22例)、腹腔淋巴结肿大(23例)、双肺斑片影(17例)等。30株非结核分枝杆菌(NTM)中,鸟分枝杆菌复合群(MAC)17株,堪萨斯分枝杆菌5株,其他8株。药敏试验显示,对多种抗结核药不同程度耐药,多耐药率86.7%,耐多药率70.0%,广泛耐药率43.3%。25例患者接受正规抗NTM治疗及高效联合抗病毒治疗(HAART),共治愈22例,死亡8例。死亡患者NTM广泛耐药率显著高于存活患者(P0.05),且接受规范NTM治疗及HAART比例均明显低于后者(P0.05)。结论 AIDS合并DNTM病原以MAC多见,耐药情况严重,广泛耐药可能与患者死亡相关,接受正规抗NTM治疗及HAART仍效果显著。
[Abstract]:Objective to investigate the clinical, etiological characteristics and therapeutic outcome of AIDS combined with disseminated nontuberculous Mycobacterium tuberculosis (DNTM), and to improve the diagnosis and treatment of the disease.Methods the clinical data of 30 patients with AIDS complicated with DNTM were analyzed retrospectively and the difference between survival and death was compared.Results there were 26 males and 4 females with an average age of 35.5 卤7.8 years.The main clinical manifestations were as follows: 28 cases of fever, 23 cases of cough, 17 cases of expectoration, 16 cases of afternoon fever). The median value of CD4 T lymphocytes was 5 渭 L / L 0 ~ 63 / 渭 L, ESR was increased in 25 cases, anemia in 26 cases, leukopenia in 12 cases, leukocytosis in 5 cases.7 patients with thrombocytopenia and 30 patients with thrombocytopenia had different degrees of chest and abdominal CT imaging abnormalities.There were 21 cases of hepatomegaly, 24 cases of splenomegaly, 22 cases of thoracic lymph node enlargement, 23 cases of celiac lymphadenopathy and 17 cases of bilateral pulmonary smear.There were 5 strains of Mycobacterium Kansas and 8 strains of others.The drug sensitivity test showed that the multidrug resistance rate was 86.7%, the multidrug resistance rate was 70.0%, and the extensive drug resistance rate was 43.3%. 25 patients received regular antituberculotic therapy and highly effective antiviral therapy. 22 cases were cured and 8 cases died.The rate of extensive drug resistance of NTM in the dead patients was significantly higher than that in the surviving patients (P 0.05), and the proportion of patients receiving standard NTM treatment and HAART were significantly lower than that of the latter.Conclusion MAC is the most common pathogen of AIDS combined with DNTM, and the drug resistance is serious. Extensive drug resistance may be related to death of patients. The effect of regular anti- therapy and HAART is still significant.
【作者单位】：广州市第八人民医院;
【基金】：广州市医药卫生科技项目(20151A011033) 国家自然青年基金(81301480) 广东省省级科技计划项目(2014A020212425)~~
【分类号】：R512.91;R516

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