摘要
目的探讨人类免疫缺陷病毒(HIV)感染合并鸟分枝杆菌复合群(MAC)病的临床特点,以提高其临床诊断和治疗水平。方法回顾性分析2011年1月至2021年7月于首都医科大学附属北京地坛医院住院经淋巴结穿刺活检组织学病理、肺泡灌洗液细胞学病理或二代测序技术(NGS)等确诊的HIV感染合并MAC病患者的临床资料,包括其临床表现、受累脏器、影像学表现、治疗以及预后等。年龄、白细胞计数、白蛋白、C-反应蛋白等呈正态分布,以x±s表示;CD4^(+)T淋巴细胞水平、HIV RNA载量、抗反转录病毒治疗(ART)治疗时长等为非正态分布计量资料,以中位数(四分位数)[M(P25,P75)]表示。计数资料(性别、致病菌种和受累脏器等)以[例(%)]表示。结果入组HIV感染合并MAC病患者共13例,其中男性10例、女性3例,平均年龄(30.15±6.5)岁。HIV合并MAC病患者CD4^(+)T淋巴细胞水平显著减低,CD4^(+)T淋巴细胞计数为[34(12.5,82)]个/μl。累及器官以淋巴结受累最为常见(61.5%、8/13),其次为肺(23.1%、3/13)。HIV感染合并MAC病最常见菌种为鸟分枝杆菌(76.9%、10/13),其次为胞内分枝杆菌(15.4%、2/13)。发热是HIV感染合并MAC病最常见的临床表现,占76.9%(10/13),其中90%(9/10)患者体温峰值超过39℃。HIV感染合并MAC肺病最常见的影像表现为斑片实变影,常伴纵膈淋巴结肿大。13例患者CD4^(+)T细胞计数为34(12.5,82)个/μl,53.8%(7/13)患者水平低于50个/μl。所有患者均根据菌种鉴定结果行经验性治疗,最常用的药物为大环内酯类(阿奇霉素或克拉霉素)[92.3%(12/13)]和乙胺丁醇[92.3%(12/13)]。结论在HIV感染人群中,MAC可累及全身多脏器,患者可出现高热、淋巴结受累,菌种主要鉴定为鸟分枝杆菌。应积极获取患者淋巴结、肺泡灌洗液等病理结果,尽早明确诊断,及时治疗。
Objective To summarize the clinical characteristics ofMycobacterium avium(M.avium)complex(MAC)disease in human immunodeficiency virus(HIV)-infected patients,and to provide reference and evidence for clinical diagnosis and treatment of HIV-MAC.MethodsA retrospective analysis was performed on histological pathology of lymph node biopsy,cytological pathology of alveolar lavage fluid or next generation sequencing technology(NGS)in Beijing Ditan Hospital,Capital Medical University from January 2011 to July 2021,including the clinical manifestations,affected organs,imaging findings,treatment and prognosis of patients with HIV infection and MAC.Age,white blood cell count,albumin and C-reactive protein were normal distribution,expressed as±s.CD4+T lymphocyte level,HIV load,antiretroviral treatment(ART)treatment duration were non-normal distribution measurement data,expressed as[M(P25,P75)].The enumeration data(gender,pathogenic bacteria,involved organs,etc.)were expressed as[case(%)].ResultsTotal of 13 patients were enrolled,among whom,10 cases were male and 3 cases were female,with an average age of(30.15±6.5)years old.The median CD4+T count was[34(12.5,82)]cells/μl.Lymph node(61.5%,8/13)involvement was the most common,followed by lung(23.1%,3/13).There were 10 cases(76.9%,10/13)infected withM.avium,2 cases(15.4%,2/13)withM.intercelleulare.Fever(76.9%,10/13)was the most common clinical symptom of HIV infected patients associated with MAC.Most of the patients had a high fever.The peak temperature of 90%(9/10)cases was higher than 39℃.The frequent imaging findings of chest CT were patchy consolidation and lymphadenectasis.The CD4+T cell count of 13 patients was[34(12.5,82)]cells/μl,and the level of 53.8%(7/13)patients was lower than 50 cells/μl.All patients underwent empirical treatment according to the results of strain identification,and the most commonly used drugs were macrolides(azithromycin or clarithromycin)[92.3%(12/13)]and ethambutol[92.3%(12/13)].ConclusionsThe most common MAC species wasM.aviumin our ser
作者
汤艳芬
赵雯
马成杰
刘刚
陈奇
刘菁
薛天娇
刘岩岩
陈融佥
王宇
Yanfen Tang;Wen Zhao;Chengjie Ma;Gang Liu;Qi Chen;Jing Liu;Tianjiao Xue;Yanyan Liu;Rongqian Chen;Yu Wang(Department of Respiratory Medicine,National Clinical Key Department of Infectious Diseases,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Emergency of Infectious Diseases,National Clinical Key Department of Infectious Diseases,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2022年第5期348-353,共6页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
"十三五"科技重大专项课题(No.2017ZX10205502)
红丝带4号方治疗艾滋病免疫重建不良临床研究(No.首发2022-2-2176)
