摘要
目的:总结分析艾滋病合并结核性胸腔积液患者临床特点。方法:回顾性分析2017年1月2020年12月广州医科大学附属市八医院收治的27例胸腔积液结核分枝杆菌培养阳性的艾滋病患者的临床资料,统计临床症状出现频率,分析各指标诊断阳性率。结果:27例患者主要临床表现为气促、咳嗽、发热,分别占81.5%(22/27)、77.8%(21/27)和74.1%(20/27)。55.6%(15/27)表现为单侧胸腔积液,其中大量胸腔积液者占59.3%(16/27),66.7%(18/27)合并肺结核,66.7%(18/27)合并纵膈或支气管肺门淋巴结肿大;24例(88.9%)CD4+T淋巴细胞计数≤200个/μL,26例(96.3%)血沉异常,24例(88.9%)合并低蛋白血症,17例(63.0%)合并贫血。胸腔积液性质均为渗出液,细胞数最高为12482×10^(6)/L,中位数为1150×10^(6)/L,21例(77.8%)以淋巴细胞为主,ADA≥30 U/L的阳性率为63.0%(17/27),LDH≥200 U/L的阳性率为92.6%(25/27)。PPD、血T-SPOT.TB、胸腔积液GeneXpertMTB/RIF阳性率分别为4.3%(1/23)、74.1%(20/27)、48.1%(13/27);所有胸腔积液涂片均未找到抗酸杆菌。结论:艾滋病合并结核性胸腔积液诊断复杂,需结合临床表现及辅助检查结果进行综合判断。
Objective:To summarize and analyze the clinical characteristics of AIDS patients with tuberculous pleural effusion.Methods:The clinical data of 27 AIDS patients with pleural effusion who tested positive for Mycobacterium tuberculosis culture in the Eighth Hospital Affiliated to Guangzhou Medical University between January 2017 and December 2020 were retrospectively analyzed.The frequency of clinical symptoms was recorded,and diagnostic yields by various indicators were calculated.Results:The major clinical manifestations in the 27 patients included shortness of breath,cough,and fever,which accounted for 81.5%(22/27),77.8%(21/27)and 74.1%(20/27),respectively,of all cases.55.6%(15/27)of the patients had unilateral pleural effusion,59.3%(16/27)had massive pleural effusion,66.7%(18/27)had concomitant tuberculosis,and 66.7%(18/27)had enlargement of mediastinal or bronchopulmonary hilar lymph nodes.Twenty-four patients(88.9%)had CD4+T lymphocyte counts≤200/μL,26(96.3%)had abnormal erythrocyte sedimentation rate,24(88.9%)had hypoproteinemia,and 17(63.0%)had anemia.The pleural effusion was exudate,with the highest and median cell counts being 12482×10^(6)/L and 1150×10^(6)/L.In 21 patients(77.8%),the cells in the pleural effusion were predominated by lymphocytes.The diagnostic yield was 63.0%(17/27)based on ADA≥30 U/L,92.6%(25/27)based on LDH≥200 U/L,and 4.3%(1/23),74.1%(20/27),and 48.1%(13/27)respectively,based on PPD,blood T-SPOT.TB,and pleural effusion GeneXpertMTB/RIF.All pleural effusion smears were negative for acid-fast bacilli.Conclusion:Diagnosis of AIDS complicated with tuberculous pleural effusion is complicated,and should rely on comprehensive judgment with clinical manifestations and ancillary investigations taken into consideration.
作者
刘新华
何浩岚
张春兰
张坚生
陈志敏
蔡卫平
Liu Xinhua;He Haolan;Zhang Chunlan;Zhang Jiansheng;Chen Zhimin;Cai Weiping(Infectious Disease Center,Eighth Hospital Affiliated to Guangzhou Medical University,Guangzhou 510060,China)
出处
《广州医科大学学报》
2021年第3期100-103,共4页
Academic Journal of Guangzhou Medical University
关键词
胸腔积液
结核
分枝杆菌
艾滋病
Pleural effusion
Tuberculosis
Mycobacterium
AIDS
