AIDS并发非结核分枝杆菌感染的临床分析

目的探讨AIDS患者合并非结核分枝杆菌(Nontuberculous mycobacteria,NTM)感染的临床特点。方法选择33例AIDS并发NTM感染患者,分析其临床特点、病变部位、免疫状态等,并与AIDS并发结核分枝杆菌(Mycobacterium tuberculosis,MTB)感染患者比较。结果 33例AIDS合并NTM感染者中,CD4+T细胞计数的中位数为18个/μl,HGB(93.8±22.9)g/L,29例患者(87.9%)出现贫血;单核细胞比例(8.66±5.08)%,16例(48.5%)单核细胞比例升高;ALB(32.7±5.2)g/L,31例(93.9%)ALB降低。播散性NTM为18例,占54.5%。病变部位以肺部为主,CT主要表现为炎症渗出,多发结节影,部位不固定,呈现弥散趋势24例(72.7%)。与同期培养为MTB感染者比较,在临床、实验室特点方面差异无统计学意义。结论 AIDS患者合并NTM多发生于免疫功能严重低下的情况,易合并贫血及低蛋白血症。NTM感染的临床特点与MTB感染不易鉴别。

Clinical features of AIDS patients with Nontuberculous mycobacteria infection

Objective To discuss the clinical features of AIDS patients with Nontuberculous mycobacteria (NTM) infection. Methods Clinical manifestations, locations, immune statuesetc. of 33 AIDS patients with NTM were analyzed, and were compared with those infected with Mycobacterium tuberculosis(MTB).Results Among 33 NTM infected patients, the median of CD4 count was 18/μL. The hemoglobin was (93.8±22.9) g/L, anemia was found in 29 patients(87.9%). The monocyte percentage was (8.66±5.08)%, rose in 16 patients (48.5%). The level of albumin was (32.7±5.2) g/L, declined in 31 patients (93.9%). Eighteen patients (54.5%) were diagnosed with disseminated NTM disease. Twenty-four patients (72.7%) presented with lesions in lung predominantly. CT showed diffuse nodules or exudative lesions or consolation. No significantly statistic differences were found between NTM and MTB infected patients in clinical, laboratory features.Conclusions Infection of NTM is an AIDS defined illness secondary to advanced immunosuppression in patients with AIDS. Both anemia and hypoproteinemia are common complications. Clinical features of NTM are not easily distinguished from MTB.