手术联合抗结核和抗病毒治疗颈部淋巴结结核并发艾滋病患者(附12例临床效果分析)

搜集2012年4月至2018年6月于苏州大学附属传染病医院经保守治疗无效,行外科手术治疗的12例(能耐受手术)颈部淋巴结结核(CTL)并发艾滋病患者的临床资料。男10例,女2例;年龄19~62岁,平均(38.0±11.3)岁。均在规范的抗结核、抗病毒药物治疗的同时辅以手术治疗,对比分析术前与术后3个月CD4 ⁺ T淋巴细胞水平、CD4 ⁺ T淋巴细胞/CD8 ⁺ T淋巴细胞比值、血红细胞沉降率(ESR)等。术后3个月CD4 ⁺ T淋巴细胞为(267.07±77.89)个/μl,术前为(156.80±84.83)个/μl,CD4 ⁺/CD8 ⁺ T淋巴细胞比值为0.68±0.53,术前为0.47±0.32,差异均有统计学意义(t=28.30,P=0.019;t=20.37,P=0.033)。术后ESR为(15.88±11.08)mm/1h,术前为(52.32±17.12)mm/1h,差异有统计学意义(t=12.92,P=0.025)。12例患者均获得随访,11例患者手术切口均一期愈合、CTL症状消失;1例切口延期愈合,经过2个月局部换药愈合;3例CTL复发再行二次手术,术后切口愈合良好;1例在治疗过程中死亡,死亡原因为艾滋病晚期且并发肺孢子虫肺炎。可见,规范的抗结核、抗病毒药物控制,联合适当时机合理精准的手术干预对CTL并发艾滋病患者治疗疗效较好。

Surgery join with anti-tuberculosis and anti-viral therapy to treat patient combined with cervical tuberculous lymphadenitis and AIDS (With 12 cases of clinical effect analysis)

The clinical data of 12 patients with cervical lymph node tuberculosis (CTL) complicated with AIDS who underwent surgical treatment were collected in the Infectious Diseases Hospital Affiliated to Soochow University from April 2012 to June 2018. There were 10 males and 2 females; They were 19-62(38.0±11.3)years old. Both the standard anti-tuberculosis and antiviral drugs were supplemented by surgical treatment, and the level of CD4 ⁺ T lymphocytes, the ratio of CD4 ⁺ T lymphocytes/CD8 ⁺ T lymphocytes and the rate of blood cell deposition (ESR) were compared and analyzed before and 3 months after operation. CD4 ⁺ T lymphocyte were (267.07±77.89)cells/μl after operation, preoperative level were (156.80±84.83)cells/μl, the ratio of CD4 ⁺/CD8 ⁺ T lymphocyte was 0.68±0.53, preoperative ratio was 0.47±0.32. The differences were statistically significant (t=28.30, P=0.019; t=20.37, P=0.033). The postoperative ESR was (15.88±11.08) mm/1 h, and the preoperative ESR was (52.32±17.12) mm/1 h. The difference was statistically significant (t=12.92, P=0.025). All the 12 patients were followed up, 11 patients had primary wound healing and CTL symptoms disappeared; 1 case had delayed wound healing and healed after 2 months of local dressing change; 3 cases had recurrence of CTL, and the wound healed well after operation; 1 case died in the course of treatment, the cause of death was late AIDS and complicated with refractory pneumocystis pneumonia. Normalized control of anti-tuberculosis and antiviral drugs, combined with reasonable and precise surgical intervention at appropriate time, has a better therapeutic effect on patients with cervical lymph node tuberculosis complicated with AIDS.