高海拔地区艾滋病合并肺结核与单纯肺结核的临床分析

目的：总结高海拔地区艾滋病合并肺结核的临床特点，以便提高对其的认识。方法：选取我科2009年—2012年收治的艾滋病合并肺结核病例共30例为观察组（A组），2012年我科收治的单纯肺结核病例30例为对照组（B组）进行对比分析。结果：A组发热、体重减轻者所占比例，明显高于B组（P〈0．01），而咳嗽、咯血及盗汗病例所占比例，低于B组（P〈0．01或P〈0．05）；A组PPD试验阳性率及血结核抗体检测阳性率显著低于B组（P〈0．01或P〈0．05）；A组痰找抗酸杆菌、痰结核杆菌培养阳性率显著低于B组（P〈0．01）；A组影像学表现纵膈淋巴结肿大、弥漫性浸润、粟粒性阴影病例所占比例多于B组（P〈0．005），而合并空洞率显著低于B组（P〈0．01）；A组外周血CD3^＋T细胞值低于B组（P〈0．05），CD8^＋T细胞值高于B组（P〈0．05），CD4^＋T细胞值、CD4^＋／CD8^＋比值明显低于B组（P〈0．01）；A组合并肺外结核例数多于B组（P〈0．01），且A组合并肺外结核率与CD4^＋T淋巴细胞计数相关。结论：高海拔地区艾滋病合并肺结核临床特征不典型，给临床诊治带来了一定的困难。

Comparison Study between AIDS Complicated with Tuberculosis and

objective： To summarize the clinical characteristics of AIDS （ acquired immunodeficiency syndrome, AIDS） complicated with tuberculosis at high altitude area, in order to improve the understanding of it. Methods：30 cases of patients with AIDS tuberculosis from 2009 to 2012 admitted in our department was selected as observation group （group A） and 30 cases of patients with simple pulmonary tuberculosis admitted in our depamnent in 2012 was selected as control group （ group B）. Results： the percentage of fever, weight loss in group A was obviously higher than that of group B （ P 〈 0. 01 ）, while the percentage of cough, hemoptysis is lower than group B （P 〈 0.01 ）, and the percent of night sweats lower than group B （P 〈 0.05 ） ; the positive rate of PPD test in group A was significantly lower than that of in group B （P 〈 0.01 ） and the positive rate of blood tuberculosis antibody de- tection is lower than group B （ P 〈 0. 05） ; the positive rate of acid fast bacilli in sputum and mycobacterium tuber- culosis culture in sputum in group A was significantly lower than that of group B （ P 〈 0.01 ） ; A set of imaging findings , such as enlargement of mediastinal lymph node, diffuse infiltration, miliary shadows in group A was much more than group B （ P 〈 0.005 ）, and merge empty rate is significantly lower than that of group B （P 〈 0.01 ） ; the value of peripheral CD3^＋ T cells in group A lower than that of group B （P 〈 0. 05）, and CD8^＋ T cells higher than group B （P 〈0.05） ,and the levels of CD4^＋ T cells and the ratio of CD4＋/CD8^＋ was lower than that in group B （P 〈0.01 ） ; the complication of extrapulmonary tuberculosis in A group was more than group B （P 〈0.01 ）, and the complication of extrapulmonary tuberculosis rate in group A was correlated with CD4^＋ T lymphocyte count. Conclusion：Atypical clinical characteristics are shown in AIDS complicated with tuberculosis at high altitude area, and it may result in certain difficulties for clinical diagnosis and treatment.