HIV感染合并耐多药肺结核的成因及疗效观察

目的 了解人类免疫缺陷病毒（HIV）感染合并耐多药肺结核（MDR-TB）的成因及治疗效果.方法 对河南省某艾滋病高发地区确诊的24例HIV（＋）合并耐多药肺结核进行分析.结果 24例HIV（＋）合并MDR-TB患者均为获得性耐药,化疗方案不合理、对患者管理不善、药物的毒副作用、免疫抑制、耐受性差为其主要原因.经过抗病毒及9～12个月抗结核治疗,死亡率29.2%（7/24）,存活者痰菌阴转率88.2%（15/17）,病灶吸收率94.1%（16/17）,空洞缩小率66.7%（4/6）,临床症状、体征有所改善,CD4^＋淋巴细胞数较治疗前提高（P〈0.05）.结论 HIV（＋）合并MDR-TB,治疗困难,死亡率高,抗病毒及多药联合抗痨治疗近期效果较好.

Cause and treatment of multi-drug resistant pulmonary tuberculosis in patients with human immunodeficiency virus infection

ObjectiveTo explore the cause and treatment of multi-drug resistant pulmonary tuberculosis (MDR-TB) in patients with human immunodeficiency virus (HIV) infection. Methods24 cases with HIV and MDR-TB who were found in some AIDS-high areas in Henan were analyzed.ResultsAll cases were later-required drug-resistant ones. The main reasons were unreasonable plan for chemotherathy,improper management to the patients, side-effect of drugs,immunosuppression and low drug-tolerance. After anti-virus and 9~12 months long anti-tuberculosis chemotherathy,7 cases died and other 17 survival patients improved in clinical symptoms and signs, including no tubercle bacillus were found in sputum of 15 cases,the focal of infection were absorbed in 16 cases,the pulmonary cavity closure rate was 66.7%(4/6)and the count of CD_4~+ lymphocyte was higher than before.ConclusionThe patients with HIV and MDR-TB are difficult to cure and the mortality rate is high;the short-term effect of the anti-virus and multi-drug antituberculosis chemotherathy is better.