艾滋病合并耐多药结核病临床研究

目的分析艾滋病合并耐多药结核病的临床特征，指导临床诊断及治疗。方法对我院2004年1月至2008年12月住院的HIV／TB双重感染与HIV抗体阴性的结核病患者痰液或／和体液进行结核分枝杆菌培养，培养阳性者做菌种鉴定及耐药检测（INH、RFP、EMB、SM），对比两组患者耐多药结核病的发病率，并对HIV／TB双重感染中耐多药结核病的CD4T淋巴细胞、X线胸片及转归等结果进行分析。结果HIV／TB双重感染者中结核分枝杆菌培养阳性149株，其中耐多药28株，初始耐多药、获得耐多药及总耐多药率分别为18．66％、20．0％、18．79％，与同期HIV阴性结核病组相比，初始耐多药发病率高。感染途径以性传播为主，CD4T淋巴细胞绝对计数明显下降，胸部x线表现不典型，住院期间死亡率达32．14％。结论艾滋病合并耐多药结核病发病率高，治疗困难，死亡率高。

Clinical research between AIDS and tuberculosis with multi-drug resistance

Objectives To analyze the clinical features of AIDS and tuberculosis with multi-drug resistance and to guide clinical diagnosis and treatment. Methods Cultured mycobacterium tuberculosis in sputum and/or fluids in patients with TB at our hospital（ Nanning, China）from Jan. 2004 to Dec. 2008. These patients were in double infection of human immunodeficiency virus（ HIV）/tuberculosis （ TB）, or patients of TB with HIV negative antibody. Further for the positive specimens, identified the culture and detected drug susceptibility of INH, RFP, EMB and SM. The incidences of tuberculosis with multi-drug resistance in patients of the two groups were compared, the results of CD4T lymphocytes,X ray film and prognosis of tuberculosis in double infection of HIV/TB were analyzed. Results 149 speci- mens were detected positive in double infection of HIV/TB, therein 28 samples were multi-drug resisted. Respectively the rates of initial drug resistance,acquired multi-drug resistance and total multi-drug resistance were 18.66% ,20. 0% and 18.79%. Compared to the corresponding period of TB with HIV negative antibody, the rate of initial drug resistance got higher. The primary infection way was through sex transmission;absolute counting of CIM T lymphocytes decreased significantly; X ray film was atypical; the mortality of admission got 32. 14%. Conclusion AIDS with TB of multi-drug resistance have got high incidence, hard treatment and high mortality.