本文選題：艾滋病 + 播散性非結(jié)核分枝桿菌病��； 參考：《中國艾滋病性病》2017年11期

【摘要】：目的了解艾滋病(AIDS)合并播散性非結(jié)核分枝桿菌病(DNTM)的臨床、病原學(xué)特點(diǎn)及治療轉(zhuǎn)歸,提高該病診療水平。方法回顧性分析30例血培養(yǎng)確定AIDS合并DNTM患者的臨床資料,比較存活與死亡患者的差異。結(jié)果 30例患者男性26例,女性4例,平均年齡(35.5±7.8)歲。主要臨床表現(xiàn):發(fā)熱(28例)、咳嗽(23例)、咳痰(17例)、午后發(fā)熱(16例)等。CD4+T淋巴細(xì)胞中位數(shù)5個(gè)/μL(0~63個(gè)/μL)、血沉升高25例、貧血26例、白細(xì)胞降低12例、白細(xì)胞升高5例、血小板減少7例。30例患者均出現(xiàn)不同程度胸腹部CT影像學(xué)異常,主要包括:肝腫大(21例)、脾腫大(24例)、胸腔淋巴結(jié)腫大(22例)、腹腔淋巴結(jié)腫大(23例)、雙肺斑片影(17例)等。30株非結(jié)核分枝桿菌(NTM)中,鳥分枝桿菌復(fù)合群(MAC)17株,堪薩斯分枝桿菌5株,其他8株。藥敏試驗(yàn)顯示,對(duì)多種抗結(jié)核藥不同程度耐藥,多耐藥率86.7%,耐多藥率70.0%,廣泛耐藥率43.3%。25例患者接受正規(guī)抗NTM治療及高效聯(lián)合抗病毒治療(HAART),共治愈22例,死亡8例。死亡患者NTM廣泛耐藥率顯著高于存活患者(P0.05),且接受規(guī)范NTM治療及HAART比例均明顯低于后者(P0.05)。結(jié)論 AIDS合并DNTM病原以MAC多見,耐藥情況嚴(yán)重,廣泛耐藥可能與患者死亡相關(guān),接受正規(guī)抗NTM治療及HAART仍效果顯著。
[Abstract]:Objective to investigate the clinical, etiological characteristics and therapeutic outcome of AIDS combined with disseminated nontuberculous Mycobacterium tuberculosis (DNTM), and to improve the diagnosis and treatment of the disease.Methods the clinical data of 30 patients with AIDS complicated with DNTM were analyzed retrospectively and the difference between survival and death was compared.Results there were 26 males and 4 females with an average age of 35.5 鹵7.8 years.The main clinical manifestations were as follows: 28 cases of fever, 23 cases of cough, 17 cases of expectoration, 16 cases of afternoon fever). The median value of CD4 T lymphocytes was 5 渭 L / L 0 ~ 63 / 渭 L, ESR was increased in 25 cases, anemia in 26 cases, leukopenia in 12 cases, leukocytosis in 5 cases.7 patients with thrombocytopenia and 30 patients with thrombocytopenia had different degrees of chest and abdominal CT imaging abnormalities.There were 21 cases of hepatomegaly, 24 cases of splenomegaly, 22 cases of thoracic lymph node enlargement, 23 cases of celiac lymphadenopathy and 17 cases of bilateral pulmonary smear.There were 5 strains of Mycobacterium Kansas and 8 strains of others.The drug sensitivity test showed that the multidrug resistance rate was 86.7%, the multidrug resistance rate was 70.0%, and the extensive drug resistance rate was 43.3%. 25 patients received regular antituberculotic therapy and highly effective antiviral therapy. 22 cases were cured and 8 cases died.The rate of extensive drug resistance of NTM in the dead patients was significantly higher than that in the surviving patients (P 0.05), and the proportion of patients receiving standard NTM treatment and HAART were significantly lower than that of the latter.Conclusion MAC is the most common pathogen of AIDS combined with DNTM, and the drug resistance is serious. Extensive drug resistance may be related to death of patients. The effect of regular anti- therapy and HAART is still significant.
【作者單位】： 廣州市第八人民醫(yī)院;
【基金】：廣州市醫(yī)藥衛(wèi)生科技項(xiàng)目(20151A011033) 國家自然青年基金(81301480) 廣東省省級(jí)科技計(jì)劃項(xiàng)目(2014A020212425)~~
【分類號(hào)】：R512.91;R516

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