艾滋病合并肺结核10例临床分析

目的探讨艾滋病合并肺结核的临床特点，治疗及预后。．方法对上海市公共卫生临床中心2005年1月至2005年12月间收治的10例艾滋病合并肺结核病人和5例艾滋病未合并肺结核病人（仅用于病死率与CD4细胞计数对照）的临床特点进行分析。结果10例艾滋病合并肺结核病人中青壮年占90％（9／10），半年内病死4例（40％，4／10）；HIV感染途径为静脉吸毒1例（10％，1／10），输血或血液制品3例（30％，3／10），性接触6例（60％，6／10）；临床表现为持续发热（100％），咳嗽、咳痰（70％，7／10），明显消瘦（80％，8／10），淋巴结肿大（40％，4／10），皮肤溃烂（20％，2／10），X线表现为血行播散型肺结核（80％，8／10），合并淋巴结结核（20％，2／10）；蛋白纯化衍生物（PPD）试验弱阳性1例（10％，1／10）；经抗结核及抗HIV治疗，病人多数症状、体征及胸片改善；抗结核治疗不良反应发生率高。结论艾滋病合并肺结核发病急，症状重，多见高热不退及血行播散型肺结核，病死率高。病死率与CD4细胞计数相关。10例病人治疗前CD^＋4明显低于5例未合并结核病的艾滋病病人（P〈0．05）；而10例中，4例病死病人治疗前CD^＋4也较存活病人明显降低（P〈0．05）。PPD试验阳性率低，抗结核药物治疗不良反应多，临床应尽可能同时进行抗结核与抗HIV治疗。

The analysis of 10 AIDS cases with concurrent Pulmonary Tuberculosis

Objective To investigate clinical characteristics, treatment and prognosis of AIDS patients with Pulmonary Tuberculosis. Methods The clinical characteristics were analyzed for ten AIDS patients with Pulmonary Tubersulosis and five AIDS patients without Pulmonary Tuberculosis （as control of mortality and CD4 cell count） treated at the Shanghai Public Health Clinical Center from January 2005 to December 2005. Results Ten AIDS patients with Pulmonary Tuberculosis accounted for 90 percent of young adults, 4 cases died within half year （40%, 4/10）; HIV-infected by intravenous drug abuse is 1 case （10%, 1/10）, by 3 cases of blood contact （30%, 3/10）, and 6 cases of sexually transmitted （60%, 6/10）. Clinical manifestations showed sustained fever （100%）, cough （70%, 7/10）, weight loss （80%, 8/10）, swollen lymph nodes （40%, 4/10）, skin ulcers （20%, 2/10）, X-ray examination showed hematogenous disseminated pulmonary tuberculosis （80%, 8/10）, merged with lymph node tuberculosis （20%, 2/10）; Purified protein derivative test （PPD） was weakly positive for 1 case （10%, 1/10）. After anti-tuberculosis and anti-HIV treatments, most patients had improvement in clinical symptoms and chest radiograph; but the incidence of adverse reaction to anti-tuberculosis treatment is high. Conclusions AIDS patients with pulmonary tuberculosis had acute symptoms and complicated illness; they often showed high-sustained fever, hematogenous disseminated pulmonary tuberculosis and high mortality, case fatality rate is associated to CD4 cell count. Before treatment, ten AIDS patients with tuberculosis had significantly lower CD4 cell count than five AIDS patients without tuberculosis （P〈0.05）; among 10 cases, four died patients had lower CD4 cell count than other patients before treatment （P〈0.05）. PPD test positive rate is low, and the incidence of adverse reactions to anti-tuberculosis drug is high. Combination of anti-HIV and anti-tuberculosis is very practical way in clinical tre