126例HIV/结核分枝杆菌合并感染临床观察

目的 观察治疗HIV/结核分枝杆菌(Mycobacterium tuberculosis, MTB)合并感染的临床疗效. 方法 分析126例HIV/MTB合并感染者的临床疗效,统计高效抗反转录病毒治疗(highly active antiretroviral therapy, HAART)后1年内免疫重建炎症反应综合征(immune reconstitution inflammatory syndrome, IRIS)发病率及CD4+T淋巴细胞上升水平. 结果 126例均完成了抗结核治疗,HAART 1年内无死亡及复发结核病例. HAART后CD4+T淋巴细胞计数逐渐升高,以12周时上升幅度最大.治疗过程中37 例(29.37%)出现IRIS.CD4+ T 淋巴细胞计数＜200 个/mm3组IRIS 发病率高于≥200 个/mm3组（χ2=6.206,P=0.013）,且在HAART 后12 周及48 周CD4+ T 淋巴细胞上升幅度低于≥200 个/mm3组（P＜0.05）.结论HIV/MTB 合并感染者在CD4+ T 淋巴细胞≥200 个/mm3时接受HAART,IRIS 发病率低,免疫重建良好.

Clinical analysis of 126 patients with HIV and Mycobacterium tuberculosis coinfection

Objective To investigate the therapeutic efficacy on HIV and Mycobacterium tuberculosis ( MTB ) coinfection . Methods The incidence of immune reconstitution inflammatory syndrome (IRIS) and the increased level of CD4+T lymphocyte count were observed within one year after giving highly active antiretroviral therapy (HAART) in 126 patients with HIV/MTB coinfection, so as to analyze the clinical effects. Results All the 126 patients completed TB treatment and within one year after receiving HAART, there were no death and reoccurrence of TB. CD4+T lymphocyte count increased gradually after HAART and increased the most greatly at week 12. During the treatment, IRIS was found in 37 patients (29.37%). The incidence of IRIS in patients with CD4+T lymphocyte count less than 200 cells/mm3 was higher than that in patients with CD4+T lymphocyte count equal to or more than 200 cells/mm3 (χ2=6 . 206 , P=0 . 013 ) . The increases in CD4+ T lymphocyte count at week 12 and 48 in patients with CD4 + T lymphocyte count less than 200 cells/mm3 were less than those in patients with CD4+ T lymphocyte count equal to or more than 200 cells/mm3 (P<0.05). Conclusions The patients with HIV/MTB coinfection who initiate HAART when their CD4+T lymphocyte counts are equal to or more than 200 cells/mm3 have a low incidence of IRIS, showing a good immune reconstitution.