|本期目录/Table of Contents|

[1]蒙志好,左 勇,邬剑威,等.艾滋病合并非结核分枝杆菌病患者的临床特点及预后分析[J].传染病信息,2018,06:544-547.
 MENG Zhi-hao,ZUO Yong,WU Jian-wei,et al.Clinical characteristics and prognosis of AIDS patients with nontuberculous mycobacterial disease[J].Infectious Disease Information,2018,06:544-547.
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艾滋病合并非结核分枝杆菌病患者的临床特点及预后分析(PDF)

《传染病信息》[ISSN:1007-8134/CN:11-3886/R]

期数:
2018年06期
页码:
544-547
栏目:
论 著
出版日期:
2018-12-30

文章信息/Info

Title:
Clinical characteristics and prognosis of AIDS patients with nontuberculous mycobacterial disease
作者:
蒙志好左 勇邬剑威沈银忠
545005 柳州,广西壮族自治区龙潭医院感染性疾病科 (蒙志好、左勇、邬剑威);201508,上海市公共卫生临床中心感 染与免疫科(沈银忠)
Author(s):
MENG Zhi-hao ZUO Yong WU Jian-wei SHEN Yin-zhong*
Department of Infectious Diseases, Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou 545005, China
关键词:
艾滋病非结核分支杆菌病抗反转录病毒治疗
Keywords:
AIDS nontuberculous mycobacterial disease antiretroviral therapy
分类号:
R512.91;R378.91
DOI:
10.3969/j.issn.1007-8134.2018.06.012
文献标识码:
A
摘要:
目的 探讨艾滋病合并非结核分枝杆菌病患者的临床特点及预后。方法 选取2012 年11 月—2015 年3 月广 西壮族自治区龙潭医院收治的符合选例标准的艾滋病合并非结核分枝杆菌病患者29 例作为研究对象,分析其临床表现、抗 非结核分枝杆菌治疗和抗反转录病毒治疗的效果及转归。结果 29 例患者中,非结核分枝杆菌肺病确诊和临床诊断病例各 13 例(各占44.8%)、肠炎2 例、淋巴结炎1例。同时伴有2 个部位以上病变者10 例(34.5%)。临床症状以乏力(28/29, 96.6%)、纳差(27/29,93.1%)、发热(24/29,82.8%)为主要表现,发热多为高热,其他常见的临床表现包括咳嗽(19/29, 65.5%)、体质量减轻(23/29,79.3%)和淋巴结肿大(16/29,55.2%)。基线CD4+ T 淋巴细胞中位数23 个/μl,伴有轻、 中度贫血者9 例(31.0%),痰涂片抗酸杆菌阳性4 例(13.8%)、痰培养抗酸杆菌阳性21 例(72.4%),其他标本培养抗 酸杆菌阳性8 例(27.6%),经鉴定均为非结核分枝杆菌。胸片提示肺内有病灶、心包或胸腔积液、纵隔淋巴结肿大25 例(86.2%)。 经抗非结核分枝杆菌及抗病毒治疗,23 例(79.3%)有效,死亡4 例,自动退出2 例。23 例有效病例72 周时痰及其他标本 培养均为阴性,肿大的浅表及腹腔淋巴结全部缩小或消失,其中21 例患者胸片提示肺部病灶完全吸收,2 例肺部病灶大部 分吸收,免疫功能均得到重建。结论 艾滋病合并非结核分枝杆菌病多发生于免疫力低下患者,以肺部受累多见,常累及多 个部位,临床上主要表现为乏力、纳差、发热、咳嗽、体质量减轻和淋巴结肿大,规范治疗后预后良好。
Abstract:
Objective To explore the clinical characteristics and prognosis of AIDS patients with nontuberculous mycobacterial disease (NTMD). Methods Twenty-nine AIDS patients with NTMD who met the inclusion criteria of the National “Twelfth Five-Year Plan” Science and Technology Major Project were enrolled from Longtan Hospital of Guangxi Zhuang Autonomous Region from November 2012 to March 2015. Clinical manifestations, anti-NTMD treatment, anti-retroviral treatment and outcomes of 29 patients were analyzed. Results Among the 29 patients, 13 cases (44.8%) had confirmed pulmonary NTMD, 13 cases (44.8%) had probable pulmonary NTMD, 2 cases had enteritis and 1 case had lymphadenitis. Ten cases (34.5%) were involved in more than 2 organs. The main clinical presentations included fatigue (28/29, 96.6%), anorexia (27/29, 93.1%), fever (24/29, 82.8%), most patients had high fever and showed cough (19/29, 65.5%), weight loss (23/29, 79.3%) and lymphadenopathy (16/29, 55.2%). The median of baseline CD4+ T lymphocytes was 23/μl, 9 cases (31%) had mild to modest anemia, 4 cases (13.8%) were positive for sputum acid bacilli smear, 21 cases (72.4%) were positive for sputum culture of acid-fast bacillus, 8 cases (27.6%) positive for other specimens of acid-fast bacillus, which were identified as nontuberculous mycobacterium. Twenty-five cases (86.2%) had lesions in the lung, pericardial or pleural effusion, mediastinal lymphadenopathy on chest radiography. After ant-NTMD and antiviral treatment, 23 cases (79.3%) achieved good treatment response, 4 cases died and 2 cases were withdrawn automatically. The sputum and other specimens were negative by smear and culture in the effective 23 cases at 72 weeks. The swelling superficial and peritoneal lymph nodes were all narrowed or disappeared. Among them, 21 cases showed complete absorption of lung lesions by chest radiography, 2 cases showed major absorption of lung lesions, and immune function was well rebuilt. Conclusions  NTMD is prevalently occurred in AIDS patients with severe immune deficiency. NTMD mostly involves in the lung and often involves many organs. The main manifestations are fatigue, anorexia, fever, cough, weight loss and lymph node enlargement, and the prognosis is good after standardized treatment.     

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备注/Memo

备注/Memo:
[ 基金项目] 国家科技重大专项(2017ZX10202101,2012ZX1001003)
[ 作者单位] 545005 柳州,广西壮族自治区龙潭医院感染性疾病科 (蒙志好、左勇、邬剑威);201508,上海市公共卫生临床中心感 染与免疫科(沈银忠)
[ 通信作者] 沈银忠,E-mail: shenyinzhong@shphc.org.cn
更新日期/Last Update: 2018-12-30