HIV合并肺结核与单纯肺结核的临床特征分析及抗结核治疗效果对比

目的:分析HIV合并肺结核患者的临床特征及抗结核治疗的疗效。方法:将我院收治的HIV感染合并肺结核初治患者53例作为A组,将同期收治的单纯肺结核患者176例作为B组,对两组患者临床资料、实验室检查结果以及治疗效果等进行回顾性分析。结果:A组患者并发症发生率以及肺外结核发生率显著高于B组(P0.05),A组咳嗽发生率低于B组,但发热发生率高于B组(P0.05);A组患者斑点实验、PPD实验、痰查抗酸杆菌阳性率均低于B组(P0.05),A组患者肝功能异常、肾功能异常以及CD4+计数200发生率高于B组(P0.05);A组抗结核治疗的临床疗效低于B组(P0.05);两组患者治疗后CD4+水平均高于治疗前,且B组高于A组(P0.05)。结论:与单纯感染肺结核的患者相比,HIV合并肺结核患者并发症以及肺外结核发生率较高,实验室相关检查敏感性较低,抗结核治疗的效果较差,临床应给予重视。     

应用T细胞酶联免疫斑点法诊断人类免疫缺陷病毒感染合并结核潜伏感染的实验研究

目的探讨T细胞酶联免疫斑点法(TSPOT)在我国人类免疫缺陷病毒(HIV)感染人群中用于诊断结核潜伏感染的应用价值。方法应用TSPOT-TB试剂盒对68例明确诊断的HIV感染者血液标本进行结核分枝杆菌(Mtb)特异性T细胞的检测,同时对所有病例做结核菌素纯蛋白生物(PPD)试验。结果在HIV感染者总体、CD4<200/μl和CD4>200/μl各组中,TSPOT检测阳性率分别为67.65%、44.44%和70.69%,PPD试验阳性率分别为41.18%、11.11%和46.55%,其中在HIV感染者总体及CD4>200/μl组中TSPOT检测阳性率均高于PPD试验,差异有统计学意义(P均<0.005)。TSPOT检测在CD4<200/μl组中的阳性率低于CD4>200/μl组,但差异无统计学意义(P>0.05);PPD试验在CD4<200/μl组中的阳性率远低于CD4>200/μl组,差异有统计学意义(P<0.05)。结论TSPOT检测在我国HIV感染合并结核潜伏感染的早期快速诊断中有较大应用价值,尤其是在CD4细胞计数>200/μl的HIV感染人群中,阳性率高于目前常用的PPD试验。PPD试验阳性率受CD4细胞计数水平的显著影响,而T SPOT检测不首次此因素影响。     

吸毒肺结核患者的临床特点

目的:探讨吸毒肺结核患者临床特点及吸毒对肺结核的影响.方法:对比两组结核病类型分布、临床症状、检验结果、胸部X线特点,统计学处理用SPSS11.0软件,p<0.05为差异有显著性.结果:吸毒组中临床症状、痰涂片阳性率、PPD皮试阳性率、PPD皮试强阳性率、胸部X线病变分布范围、空洞、支气管播散及病变形态有显著性差异(p<0.05).而结核病类型分布及结核抗体阳性率无显著差异(p>0.05).结论:吸毒患者肺的感染易感性明显增加,肺部防御功能受损,而吸毒能明显加重肺结核病情.     

CFP-10/ESAT-6特异性IFN-g释放反应诊断活动性肺结核的研究

前期研究已经建立了基于结核分枝杆菌特异性抗原CFP-10/ESAT-6融合蛋白刺激外周血单核细胞IFN-γ释放反应,本研究旨在证实该方法在活动性肺结核及结核菌潜伏感染诊断中的意义。实验对象包括111例当地医院收治的活动性肺结核病人(病例组)及283例某大学入学新生(健康对照者)。采集肝素抗凝血,分别加入含结核菌抗原CFP-10/ESAT-6、植物血凝素及无刺激物(PBS)的细胞培养孔中,培养过夜,次日收集血清,进行IFN-γ检测。同时,对其中58位病人志愿者及46位健康对照志愿者进行了结核菌素(PPD)皮内变态反应。病例组与健康对照组的PPD皮内变态反应阳性率分别为79.3%(46/58)和76.1%(35/46),无显著差异(P>0.05),表明PPD皮内变态反应不能用于活动性肺结核的检测。病例组IFN-γ体外释放反应的阳性率为95.5%(106/111),而健康对照组阳性率为16.3%(46/283),两组间均存在极显著差异,表明IFN-γ体外释放反应诊断活动性肺结核具有很高的灵敏度(95.5%)与良好的特异性。在健康组中,IFN-γ体外释放反应与PPD皮内变态反应的总符合率为50.0%,且IFN-g体外...     

复治肺结核患者结核分枝杆菌L型培养结果分析

目的:了解复治肺结核患者的结核分枝杆菌L型培养情况,探讨结核分枝杆菌L型阳性与耐多药的关系。方法:选择180例肺结核患者的痰标本进行结核分枝杆菌培养和结核分枝杆菌L型培养,同时对110例复治组中培养阳性的标本行耐药监测。结果:复治组的L型阳性率为43.6%,初治组的L型阳性率为15.7%,复治组显著高于初治组(P<0.01);菌阳复治组的L型阳性率50%,菌阴复治组的L型阳性率39.4%,菌阳组明显高于菌阴组(P<0.05);L型菌阳性患者的耐药率显著高于L型菌阴性组(P<0.05)。结论:结核分枝杆菌L型阳性是引起结核病复发、耐药的重要原因;MDR-TB与结核分枝杆菌L型感染有关。     

肺结核早期诊断中不同检验方法的应用分析

目的探讨肺结核早期诊断中不同检验方法的临床应用价值。方法对我院2016年4月~2017年9月收治的肺结核早期患者51例为观察组,同时选取51例非肺结核患者作为对照组,分别对两组患者实施涂片结核菌检测、皮肤结核菌素纯蛋白衍化物(PPD)及聚合酶链反应(PCR)等3种检验方法,对比分析3种检验方法在肺结核早期诊断中的临床应用价值。结果3种检验方法中,观察组的阳性率均显著高于对照组,差异均有统计学意义(P0.05)。PCR检测结核菌阳性率为72.55%,显著高于涂片结核菌检测、PPD检测的50.98%、21.57%,差异均有统计学意义(P0.05)。结论肺结核早期诊断中,3种检验方法临床效果均显著,相比于涂片结核菌检测及PPD检验、PCR检验灵敏度更高,值得临床推广使用。     

复治肺结核患者结核分枝杆菌L型培养结果分析

目的：了解复治肺结核患者的结核分枝杆菌L型培养情况,探讨结核分枝杆菌L型阳性与耐多药的关系。方法：选择180例肺结核患者的痰标本进行结核分枝杆菌培养和结核分枝杆菌L型培养,同时对110例复治组中培养阳性的标本行耐药监测。结果：复治组的L型阳性率为43．6％,初治组的L型阳性率为15．7％,复治组显著高于初治组（P〈0．01）;菌阳复治组的L型阳性率50％,菌阴复治组的L型阳性率39．4％,菌阳组明显高于菌阴组（P〈0．05）;L型菌阳性患者的耐药率显著高于L型菌阴性组（P〈0．05）。结论：结核分枝杆菌L型阳性是引起结核病复发、耐药的重要原因;MDR-TB与结核分枝杆菌L型感染有关。     

佛山市禅城区中小学生肺结核感染和患病现况

目的 了解佛山市禅城区中小学生结核菌感染和肺结核患病现况,为主管部门提供学校结核病防治工作决策依据.方法 整群抽取佛山市禅城区中小学新生19 685名进行PPD试验,检查结果采用SPSS 16.0统计分析.结果 佛山市中小学生PPD总体阳性率为52.0％,强阳性率3.6％,发现5例活动性肺结核病人,患病率为28.76/105.初中学生PPD阳性4 737例(51.5％),强阳性307例(3.3％);小学生阳性3 689例(45.1％),强阳性311例(3.8％);初中生阳性率低于小学生(χ2 =70.36,P＜0.01).受检男生中,阳性4 459例(46.1％),强阳性255例(2.6％);女生中,阳性3 967例(51.4％),强阳性363例(4.7％),女生阳性率高于男生(χ2=124.39,P＜0.01).有肺结核患者的学校PPD阳性和强阳性检出率高于无肺结核患者的学校(x2=31.76,P＜0.01),患者所在班级PPD总体阳性率高于无患者的班级(x2=9.28,P=0.01).结论 佛山市中小学学生结核菌感染率和活动性肺结核患病率较高,初中生、女生易感,患者所在班级和学校结核菌感染率较高.因此,要针对重点人群,加强佛山市中小学生结核病防治工作.     

利用结核分枝杆菌抗原特异性γ-IFN体外释放测定评估抗结核治疗疗效的临床应用价值

探讨利用结核分枝杆菌抗原特异性γ-IFN体外释放测定评估抗结核治疗疗效的临床应用价值。研究了66例培养阳性肺结核病人抗结核治疗过程中抗原特异性γ-IFN体外释放测定结果的变化,并与结核菌素皮试结果的变化相比较。结果,抗原特异性γ-IFN体外释放测定于抗结核治疗前期(满2个月)的阳性率显著高于后期(疗程满6个月)[55/66(83.3%)vs12/66(18.2%);P≤0.01],而PPD结素皮试于抗结核治疗前期及后期的阳性率分别为[50/66(75.8%)vs38/66(57.6%);P>0.05]。结论:结核分枝杆菌抗原特异性γ-IFN体外释放测定评估抗结核治疗疗效较PPD结素皮试临床应用价值更大。     

全血γ-干扰素释放试验在结核诊断中的应用价值

目的:评价全血γ-干扰素释放试验在结核病中的诊断价值。方法:将173例疑似结核病患者分为临床明确诊断肺结核63例(肺结核组)、肺外结核43例(肺外结核组)、排除结核67例(非结核组),观察各组γ-干扰素释放试验阳性率。结果:肺结核组、肺外结核组阳性率分别为85.7%(54/63)和88.4%(38/43),显著高于非结核组11.9%(8/67)(P0.01);诊断灵敏度为86.8%,特异度为88.1%。结论:全血γ-干扰素释放试验具有较高灵敏度和特异度,可用于肺结核及肺外结核的辅助诊断,适合临床推广使用。     

Xpert MTB/RIF在人类免疫缺陷病毒感染/艾滋病患者中诊断结核病的价值

为探讨利福平耐药结核分枝杆菌实时荧光定量核酸扩增检测技术(Xpert Mycobacterium tuberculosis/rifampicin,Xpert MTB/RIF)在人类免疫缺陷病毒感染/艾滋病(human immunodeficiency virus infection/acquired immunodeficiency syndrome,HIV/AIDS)患者中诊断结核病的价值,本研究回顾性分析了2018年1月1日—2020年12月31日复旦大学附属公共卫生临床中心感染与免疫科收治的801例HIV/AIDS合并疑似结核病患者的临床资料。801例患者中,657例进行了Xpert MTB/RIF、外周血结核感染T细胞斑点试验(tuberculosis T cell spot test,T-SPOT.TB)、抗酸染色涂片镜检和BACTEC MGIT 960液体培养等检测。以液体培养及菌型鉴定结果作为结核病诊断的“金标准”,确诊结核病92例,Xpert MTB/RIF、T-SPOT.TB、抗酸染色涂片镜检在HIV/AIDS患者中诊断结核病(包括肺结核和肺外结核)的灵敏度分别为72.8%、55.4%和69.6%,特异度分别为96.8%、90.3%和84.4%,与“金标准”行一致性检验,Kappa值分别为0.719 (P<0.01)、0.430(P<0.01)和0.424(P<0.01)。Xpert MTB/RIF检测502份呼吸道样本,结果显示其诊断肺结核的灵敏度和特异度分别为66.7%和96.0%;在痰涂片阳性和阴性的患者中,Xpert MTB/RIF诊断肺结核的灵敏度分别为77.4%和35.2%,特异度分别为87.7%和 97.8%。采用Xpert MTB/RIF检测343份肺外标本,结果显示其诊断肺外结核的灵敏度和特异度分别为63.3%和95.2%。以上结果提示,Xpert MTB/RIF在HIV/AIDS患者中诊断结核病(包括肺结核和肺外结核)具有较高的灵敏度和特异度,诊断肺结核的灵敏度高于肺外结核,因此推荐将其作为HIV/AIDS患者疑似结核病的首选检测方法。     

On transient effects in the HIV/AIDS epidemic

During the initially exponential spread of the human immunodeficiency virus (HIV—the causative agent of AIDS) the growth rate of the number of AIDS cases decreases from plus infinity to the growth rate of HIV infections. A sensitivity analysis shows that for all reasonable values of the parameters of the HIV epidemic (incubation period, initial doubling time, etc.) the effect of this positive transient becomes negligible when the annual number of AIDS cases reaches a few dozen. Necessary and sufficient conditions are given for the growth rate of the number of AIDS cases to be monotonically decreasing during the positive transient. A mildly pathological density function for the incubation period of AIDS provides an example of a growth rate of AIDS that does not decrease monotonically, even though HIV is spreading exponentially. A negative transient occurs when the growth rate of HIV begins to decrease. In this context a somewhat surprising result emerges under the assumption that the growth rate of HIV is non-increasing: the growth rate of AIDS is at all times larger than the growth rate of HIV. A logistic HIV epidemic illustrates this result, and implications for the growth of the HIV epidemic in the United States and Europe are discussed. In particular, it is shown that the positive transient must have passed by 1982 in the United States and by 1986 or 1987 for the five European countries with the largest caseloads.     

Evaluation of Epstein-Barr Virus Salivary Shedding in HIV/AIDS Patients and HAART Use: A Retrospective Cohort Study

Little data is available on the evaluation of the occurrence rates of Epstein-Barr virus(EBV) in saliva and relationship with highly active antiretroviral therapy(HAART) use in HIV/AIDS patients in China. We conducted a retrospective cohort study of EBV serological tests for HIV/AIDS patients who were treated in the hospitals for infectious diseases in Wuxi and Shanghai, China from May 2016 to April 2017. The EBV-seropositive samples were identified by ELISA. EBV-specific primers and probes were used for the quantitative detection of viral DNA from saliva via quantitative real-time polymerase chain reaction. CD4 cell counts of the HIV/AIDS patients were detected by a flow cytometry. A total of 372 HIV/AIDS patients were ultimately selected and categorized for this retrospective cohort study. For EBV IgG and IgM, the HIV/AIDS HAART use(H) and non-HAART use(NH) groups had significantly higher seropositive rates than the HIV-negative control group. The HIV/AIDS(NH) group had the highest seropositive rate(IgG, 94.27%; IgM, 68.98%) and the highest incidence of EBV reactivation or infection. For salivary EBV DNA-positive rates and quantities, the HIV/AIDS(H)(73.69%) and the HIV/AIDS(NH)(100%) groups showed significantly higher values than the HIV-negative control group(35.79%,[ twofold). Further, the salivary EBV DNA-negative population had significantly higher CD4 cell counts than the EBV DNA-positive population in the HIV/AIDS(H) group and the HIV/AIDS(NH) groups. Thus, HAART use is beneficial in decreasing the EBV salivary shedding in HIV/AIDS patients and indirectly decreases EBV transmission risk.     

Incidence of tuberculosis among reported AIDS cases in Quebec from 1979 to 1996

BACKGROUND: The impact of HIV infection on tuberculosis (TB) rates in Quebec has not been fully established. Because concurrent HIV infection is the single most important factor in TB reactivation, the authors used Quebec AIDS surveillance data to quantify the extent of TB among reported AIDS cases and to identify the characteristics of AIDS patients with TB. METHODS: The study population comprised people aged 15 years and over with AIDS diagnosed between Jan. 1, 1979, and Dec. 31, 1996, and reported by Mar. 13, 1997. Patients with TB (all forms) and those without TB were compared. Multivariate logistic regression analysis was used to examine the independent effect of each variable on the AIDS-TB cases. The authors also compared the number of AIDS-TB cases with the number of TB cases to estimate the effect of HIV infection on TB incidence. RESULTS: Of the 4684 people with AIDS reported in Quebec, 242 (5.2%) had active TB at some point during the course of their illness. During 1992-1995, 9.6% of the people with TB in Montreal, and 5.8% in the province of Quebec, also had HIV infection. Those with AIDS and TB were predominantly male (75.2%), manual workers (40.1%) and residents of Montreal (86.4%) and were born in an HIV-endemic country (63.8%). The multivariate analysis indicated that AIDS patients who were born in HIV-endemic countries in the Caribbean, sub-Saharan Africa or other developing regions were 21.8 times (95% confidence interval [CI] 19.5-28.5), 17.9 times (95% CI 12.7-27.1) and 4.9 times (95% CI 3.5-7.0) more likely to have TB than those born in Canada; manual workers and unemployed people with AIDS were 1.6 times (95% CI 1.3-2.0) and 2.0 times (95% CI 1.5-2.6) more likely to have TB than professional workers; and people who acquired HIV infection through heterosexual contact were 2.1 times (95% CI 1.6-3.1) more likely to have TB than men who acquired it through sexual contact with other men. INTERPRETATION: AIDS seems to contribute significantly to the number of TB cases. The results of this study reinforce the importance of offering HIV testing to people in high-risk groups, such as those born in a country where HIV and TB is endemic.     

Classification and regression tree (CART) model to predict pulmonary tuberculosis in hospitalized patients

ABSTRACT: BACKGROUND: Tuberculosis (TB) remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. METHODS: Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART) model was generated and validated. The area under the ROC curve (AUC), sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. RESULTS: We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear) and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. CONCLUSIONS: The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with clinical suspicion of TB in tertiary health facilities in countries with limited resources.     

广西人类免疫缺陷病毒感染者/艾滋病患者合并马尔尼菲篮状菌感染的特征及Mp1p抗原快速筛检的研究

为调查广西人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者/艾滋病(acquired immunodeficiency syndrome,AIDS)患者合并马尔尼菲篮状菌(Talaromyces marneffei,TM)感染的特征并评价TM Mp1p(一种甘露糖蛋白)抗原试剂...     

Granulocyte-Macrophage Colony-Stimulating Factor and Tumor Necrosis Factor Alpha in Patients with Human Immunodeficiency Virus (HIV) Type 1 Infection

Variations in cytokine production in patients with human immunodeficiency virus (HIV) infection could be involved in the physiopathology and in the progression of the disease. Therefore we studied the level of granulocyte-macrophage colony-stimulating factor (GM-CSF) and tumor necrosis factor α (TNFα) produced in patients with HIV infection at stage II (asymptomatic seropositives) and stage IV (AIDS) of the CDC classification, by using an enzyme amplified sensitivity immunoassay. We measured the level of GM-CSF and TNFα in supernatant of phytohemagglutinin-activated peripheral blood mononuclear cells from patients and healthy individuals. In one out of 10 stage II patients and 4 out of 14 stage IV patients, we obtained higher levels of GM-CSF than the mean + 2 S.D. of controls, but in 3 stage IV patients with very low CD4+ T lymphocyte counts (< 50/mm^–3) compared to other patients, the GM-CSF values were very low. High levels of TNFα were detected in 3 out of 10 stage II and 6 out of 11 stage IV patients. The high values of TNFα were associated with high values of GM-CSF in stage II and in most of AIDS patients except those with very low CD4⁺ T cell counts, who produced low levels of GM-CSF. Plasma levels of cytokines were evaluated in 10 stage II, 22 stage IV patients and 20 controls. Increased levels of GM-CSF (more than 9 pg/ml) were observed in the plasma from 8 out of 10 stage II patients and 17 out of 22 stage IV patients. The tendency that increased levels of GM-CSF were associated with increased levels of TNFα was observed in plasma from stage IV patients. We report a disarray of GM-CSF production in patients with HIV infection that could be involved in clinical manifestations and progression of the disease.     

Impact of HIV Status on Treatment Outcome of Tuberculosis Patients Registered at Arsi Negele Health Center,Southern Ethiopia: A Six Year Retrospective Study

BackgroundDespite implementation of different strategies, the burden and mortality of human immunodeficiency virus (HIV)-associated tuberculosis (TB) remains a challenge in Ethiopia. The aim of this study was to assess the impact of HIV status on treatment outcome of tuberculosis patients registered at Arsi Negele Health Center, Southern Ethiopia.MethodsA six-year retrospective data (from September 2008 to August 2014) of tuberculosis patients (n = 1649) registered at the directly observed therapy short-course (DOTS) clinic of Arsi Negele Health Center was reviewed. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Data were entered and analyzed using SPSS version 20. Multinomial logistic regression analysis was used to examine the effect of HIV status separately on default/failure and death in relation to those who were successfully treated. Odds ratios with 95% confidence intervals were used to check the presence and strength of association between TB treatment outcome and HIV status and other independent variables.ResultsOut of the 1649 TB patients, 94.7% (1562) have been tested for HIV of whom 156(10%) were HIV co-infected. The mean (standard deviation) age of the patients was 28.5(15.5) years. The majority were new TB cases (96.7%), male (53.7%), urban (54.7%), and had smear negative pulmonary TB (44.1%). Overall, the treatment success rate of TB patients with or without HIV was 87.3%. Using cure/completion as reference, patients without known HIV status had significantly higher odds of default /failure [aOR, 4.26; 95%CI, 1.684–10.775] and transfer-out [aOR, 2.92; 95%CI, 1.545–5.521] whereas those who tested positive for HIV had a significantly higher odds of death [aOR, 6.72; 95%CI, 3.704–12.202] and transfer-out [aOR, 2.02; 95%CI, 1.111–3.680].ConclusionOverall, treatment outcome and HIV testing coverage for TB patients is promising to reach the WHO target in the study area. However, default/failure among patients without known HIV status, and higher rate of mortality among HIV positive TB patients and transfer-out cases deserves concern. Therefore further prospective studies on quality of services, socioeconomics and psychology of this group should be conducted.     

Comparison of immunodeficiency and AIDS defining conditions in HIV negative and HIV positive men with haemophilia A.

OBJECTIVE--To investigate the hypothesis that high usage of clotting factor concentrate, rather than HIV infection, is the cause of immunodeficiency and AIDS in men with haemophilia. DESIGN--A comparison of AIDS defining conditions and CD4 counts in HIV positive and HIV negative patients with haemophilia matched for usage of clotting factor concentrate. SETTING--A comprehensive care haemophilia centre. SUBJECTS--17 HIV positive and 17 HIV negative male patients with haemophilia A (age range 12-60 at beginning of study period) who had received similar amounts of clotting factor concentrate yearly over the years 1980-90. MAIN OUTCOME MEASURES--Clinical events listed as AIDS defining in the Centers for Disease Control AIDS definition; CD4 lymphocyte counts; death. RESULTS--Of 108 HIV positive male patients with haemophilia A, only 17 could be matched to an HIV negative patient. This was due to the much higher average usage of factor VIII in the HIV positive group. Between 1980 and 1990, 16 clinical events occurred in nine of the 17 HIV positive patients. No event occurred in the 17 HIV negative patients. In each pair the mean CD4 count during follow up was, on average, 0.5 x 10(9)/l lower in the HIV positive patient. CONCLUSION--These data reject the hypothesis that high usage of clotting factor concentrate, rather than HIV infection, is the cause of immunodeficiency and AIDS in men with haemophilia.