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目的评价血液结核分枝杆菌液体培养对HIV感染者活动性结核病的诊断价值。方法 2006年8月至2008年7月,对广西省4个诊疗机构中HIV感染者进行包括临床、胸片、痰涂片、痰快速结核分枝杆菌培养和血液快速结核分枝杆菌培养在内的综合筛查以诊断活动性结核。分析结核分枝杆菌血培养在HIV感染者中的总体阳性率和在不同CD4水平患者中的阳性率,总结血培养阳性的结核病患者的临床特点,探讨血培养对结核的诊断价值。结果 602例HIV感染者在结核筛查时进行了血液结核分枝杆菌培养,7例检出结核分枝杆菌菌血症,血结核分枝杆菌培养在HIV感染者中的总体阳性率为1.2%。在CD4计数<200/μl、<100/μl和<50/μl患者组中,血培养阳性率分别为1.4%、1.8%和2.4%,逐渐增高。共诊断活动性结核133例,其中结核分枝杆菌菌血症的阳性率为5.3%。血培养阳性的结核患者中位CD4仅为17/μl,均有明确的肺部影像学改变,2例有粟粒样表现,6例同时行痰结核分枝杆菌培养,其中5例(83%)阳性,5例患者伴有明确的肺外结核。与无结核分枝杆菌菌血症的结核/HIV合并感染者相比,有结核分枝杆菌菌血症的患者BMI和CD4计数较低,盗汗症状更常见。结论血液快速结核分枝杆菌培养在广西HIV感染者中的阳性率总体较低,但随着患者免疫缺陷的加重,阳性率逐渐增高。本研究中有结核分枝杆菌菌血症的HIV感染者均有明显肺部病变,且痰培养的阳性率高,提示结核分枝杆菌血培养对提高HIV感染者中结核的诊断率作用可能有限。
Objective To evaluate the diagnostic value of Mycobacterium tuberculosis liquid culture for active tuberculosis in HIV-infected patients. Methods From August 2006 to July 2008, clinical trials, chest radiographs, sputum smear, rapid sputum smear mycobacterium tuberculosis culture and rapid blood culture of Mycobacterium tuberculosis were performed in 4 clinics in Guangxi Comprehensive screening to diagnose active tuberculosis. To analyze the overall positive rate of Mycobacterium tuberculosis blood culture in HIV-infected persons and the positive rate in patients with different CD4 levels. To summarize the clinical features of blood culture-positive TB patients and to explore the diagnostic value of blood culture for tuberculosis. Results A total of 602 cases of HIV-infected persons were tested for Mycobacterium tuberculosis culture during screening of tuberculosis, 7 cases of Mycobacterium tuberculosis were detected, and the overall positive rate of Mycobacterium tuberculosis culture in HIV-infected persons was 1.2% . In CD4 count <200 / μl, <100 / μl and <50 / μl patient groups, the positive rates of blood culture were 1.4%, 1.8% and 2.4%, respectively. A total of 133 cases of active TB were diagnosed, of which the positive rate of Mycobacterium tuberculosis was 5.3%. The median CD4 in blood-positive TB patients was only 17 / μl with clear lung imaging changes, 2 with miliary-like appearances, and 6 with sputum-producing Mycobacterium tuberculosis in 5 of them (83%) Positive, 5 patients with a clear extra-pulmonary tuberculosis. Patients with M. tuberculosis bacteremia had lower BMI and CD4 counts, and night sweats were more common than tuberculosis / HIV co-infected with tuberculosis-free bacteremia. Conclusion The positive rate of rapid Mycobacterium tuberculosis culture in HIV-infected patients in Guangxi is generally low, but with the increase of immunodeficiency in patients, the positive rate is gradually increased. Mycobacterium tuberculosis bacteremia in this study of HIV-infected patients have significant lung disease, and the positive rate of sputum culture, suggesting that the blood culture of M. tuberculosis to enhance the diagnosis of tuberculosis in HIV-infected persons may be limited .