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目的研究探索结核病(TB)合并人类免疫缺陷病毒(HIV)感染死亡病例的临床特征。方法收集2005年1月至2009年12月在上海市(复旦大学附属)公共卫生临床中心住院的TB合并HIV(TB-HIV)感染的死亡病例43例作为病例组,同时收集同期的非TB-HIV感染死亡病例67例作为对照组,比较两组的人口学资料、临床特点、放射学特征和实验室检查结果。结果病例组中肺外TB、合并真菌感染、CD4+细胞≤200个/μL等指标明显高于对照组(P<0.05),年龄、体重、痰TB菌涂片和痰TB菌培养阳性率、耐多药率、肺内存在空洞等指标明显低于对照组(P<0.05)。两组γ干扰素释放试验(IGRA)阳性率均高于结核菌素皮肤试验(TST)阳性率(P<0.05),两组IGRA阳性率和TST阳性率比较差异均无统计学意义(P>0.05)。结论在TB-HIV感染的死亡病例中肺外TB多见、合并真菌感染多见、CD4+细胞≤200个/μL多见、空洞少见、痰结核杆菌阳性率低为其主要特征,耐多药问题还不是目前TB-HIV感染病死病例的主要问题;无论TB患者是否合并HIV感染,在重症患者中,均有必要考虑应用IGRA代替TST进行TB感染的检测。
Objective To investigate the clinical characteristics of death from tuberculosis (TB) combined with human immunodeficiency virus (HIV) infection. Methods Forty-three death cases of TB-combined HIV (TB-HIV) infection hospitalized in Shanghai Public Health Clinical Center affiliated to Fudan University from January 2005 to December 2009 were collected as case group. Meanwhile, non-TB- Sixty-seven HIV-infected deaths were included as control group. Demographic data, clinical features, radiological features and laboratory findings were compared between the two groups. Results In the case group, the extra-pulmonary TB, combined fungal infection, CD4 + cells ≤200 / μL and other indicators were significantly higher than the control group (P <0.05), age, weight, sputum TB smear and sputum TB culture positive rate Multi-drug rate, the presence of holes and other indicators of the lung was significantly lower than the control group (P <0.05). The positive rate of IGRA in both groups was higher than that of tuberculin skin test (P <0.05). There was no significant difference between the two groups in the positive rate of IGRA and the positive rate of TST (P> 0.05). Conclusions Among the deaths of TB-HIV infection, extra-pulmonary TB is more common, more common with fungal infections, CD4 + cells more than 200 / μL more common, rare cavity, the low positive rate of sputum Mycobacterium tuberculosis is its main feature, multi-drug resistance It is not yet a major problem of the current death from TB-HIV infection. Whether or not TB patients have HIV infection, it is necessary to consider the use of IGRA instead of TST for the detection of TB infection in critically ill patients.