HIV/AIDS合并肺结核54例死亡病因分析

目的通过HIV/AIDS合并肺结核死亡病因分析,提高对该双重感染的诊疗水平。方法对308例HIV/AIDS合并肺结核中54例死亡患者的死因进行回顾性分析。结果CD₄⁺≥200/mm³62例,死亡2例,CD₄⁺100～199/mm³70例,死亡8例,CD₄⁺50～99/mm³82例,死亡17例,CD₄⁺＜50/mm³94例,死亡27例。抗结核治疗组268例,死亡35例,未抗结核治疗40例,死亡19例。真菌为主要死因的28例,细菌主因10例,结核病主因6例,卡氏孢子虫感染主因5例,以其他病毒为主因2例,其他死因3例,呼吸道感染为最多。结论抗结核治疗可以明显降低死亡率,当CD₄⁺较低时,病死率明显增高,且以真菌感染为主,是艾滋病合并结核病的主要死因。因此,及早抗结核治疗及HAART治疗、提高病人免疫、控制其他病原体感染尤其是真菌感染是治疗的主要措施。

Clinical analysis of 54 HIV/AIDS cases co-infected with pulmonary tuberculosis

Objective To analyse the causes of death of HIV/AIDS cases co-infected with pulmonary tuberculosis(PTB) and to improve the level of clinical diagnosis and treatment.Methods The causes of death of 54 HIV/AIDS cases co-infected with PTB in all of 308 patients were analyzed retrospectively.Results There were 62 cases with CD₄≥200/mm³,and 2 cases died;70 cases with CD₄ 100～199/mm³,and 8 cases died;82 cases with CD₄ among 55～99/mm³,and 17 cases died;94 cases with CD₄<50/mm³,and 27 cases died.There were 268 cases treated with anti-tuberculosis drugs,while 35 cases died;40 cases treated without anti-tuberculosis drugs,while 19 cases died.The main causes of death were fungus infection(28 cases),bacterial infection(10 cases),tubercle bacillus infection(6 cases),pneumocystis carinii infection(5 cases),viral infection(2 cases) and other causes(3 cases).Respiratory tract infection was the main cause.Conclusion The treatment of anti-tuberculosis may decrease the morality of these patients. When the level of CD₄ is lower,the fatality is higher compared with CD₄＞100/mm³(P＜0.05),fungus infection is the main cause of death of HIV/AIDS cases co-infected with pulmonary tuberculosis(PTB).Thus,the main Methods are anti-tuberculosis treatment at early stage,HAARTM,promoting immunity,and controlling other pathogenic infection,specially the fungus infection.