传染病信息

目的 探讨艾滋病(acquired immune deficiency syndrome, AIDS)合并肺结核(pulmonary tuberculosis, PTB)患者的临床特征，并分析其发生肺部多重感染的危险因素，为临床精准诊疗提供依据。方法 采用回顾性研究方法，选取2020年6月至2025年6月间凉山彝族自治州第七人民医院收治的900例AIDS合并PTB患者作为AIDS+PTB组，另选取同期900例单纯PTB患者作为PTB组，比较两组一般资料、临床特征及影像学表现。在AIDS+PTB组中，根据是否发生肺部多重感染分为感染组(412例)与非感染组(488例)，采用Logistic回归模型筛选AIDS合并PTB患者发生肺部多重感染的危险因素。结果 AIDS+PTB组与PTB组在气短、咳嗽等临床症状方面比较，差异均无统计学意义(均P>0.05);AIDS+PTB组发热、乏力、消瘦的发生率高于PTB组，胸痛发生率低于PTB组(均P<0.05)。AIDS+PTB组合并肺部多重感染、低蛋白血症、电解质紊乱、贫血的发生率均高于PTB组(均P<0.05)。病灶分布方面，两组患者下叶背段与上叶尖后段、两叶及两叶以上受累、双肺受累情况比较，差异均无统计学意义(均P>0.05);AIDS+PTB组淋巴结或胸膜受累比例高于PTB组(P<0.05)。影像学表现方面，AIDS+PTB组胸腔积液影、纵隔或肺门淋巴结肿大影、弥漫粟粒阴影的发生率均高于PTB组，而空洞影发生率低于PTB组(均P<0.05)。感染组与非感染组在性别、年龄、体质量指数、肺结核病程、人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染时间方面比较，差异均无统计学意义(均P>0.05)；两组在吸烟史、结核病耐药、HIV病毒载量、抗病毒治疗、治疗时间、合并支气管扩张、合并乙型病毒性肝炎、C反应蛋白升高、合并肺外结核、CD4~+T淋巴细胞计数、血红蛋白水平方面比较，差异均具有统计学意义(均P<0.05)。多因素Logistic回归分析显示，结核病耐药、合并支气管扩张、合并乙型病毒性肝炎、C反应蛋白水平升高、合并肺外结核为AIDS合并PTB患者发生肺部多重感染的危险因素，而抗病毒治疗及较高的CD4~+T淋巴细胞计数及血红蛋白水平为保护因素(均P<0.05)。结论 AIDS合并PTB患者以发热、乏力、消瘦为主要临床症状，且多合并肺部多重感染、低蛋白血症、电解质紊乱及贫血，其影像学特征与单纯PTB患者也存在显著差异。结核病耐药、合并支气管扩张、合并乙型病毒性肝炎、C反应蛋白升高、合并肺外结核是此类患者发生肺部多重感染的危险因素；而抗病毒治疗、较高的CD4~+T淋巴细胞计数及血红蛋白水平为其保护因素。

Objective To investigate the clinical characteristics of patients with acquired immune deficiency syndrome(AIDS) complicated by pulmonary tuberculosis(PTB) and analyzes the risk factors for pulmonary co-infections, so as to provide evidence for precise clinical diagnosis and treatment. Methods A retrospective study was conducted on 900 patients with AIDS and PTB admitted to our hospital as the AIDS+PTB group, and 900 patients with PTB alone during the same period as the PTB group. General data, clinical features, and imaging findings were compared between the 2 groups. Within the AIDS and PTB group, patients were divided into a co-infection group(412 cases) and a non-co-infection group(488 cases) based on the presence of pulmonary co-infections. Logistic regression models were used to identify risk factors for pulmonary co-infections in AIDS patients with PTB. Results No statistically significant difference were observed between the AIDS+PTB group and the PTB group in clinical symptoms such as shortness of breath and cough(P>0.05). The incidences of fever, fatigue, and weight loss were higher in the AIDS+PTB group than in the PTB group, while the incidence of chest pain was lower(P<0.05). The incidence of pulmonary co-infections, hypoalbuminemia, electrolyte imbalance, and anemia were all higher in the AIDS+PTB group than in the PTB group(P<0.05). Regarding lesion location, no significant differences were found between the two groups in involvement of the dorsal segment of the lower lobe, apical-posterior segment of the upper lobe, involvement of 2 or more lobes, or bilateral lung involvement(P>0.05). The proportion of lymph node or pleural involvement was higher in the AIDS+PTB group than in the PTB group(P<0.05). In terms of imaging findings, the incidences of pleural effusion, mediastinal or hilar lymphadenopathy, and diffuse miliary shadow were higher in the AIDS+PTB group than in the PTB group, while the incidence of cavitation was lower(P<0.05). No statistically significant difference were observed between the co-infection and non-coinfection groups in terms of gender, age, body mass index(BMI), duration of PTB, or duration of human immunodeficiency virus(HIV) infection(P>0.05). Significant differences were found between the two groups in smoking history, drug-resistant tuberculosis, HIV viral load, antiretroviral therapy, treatment duration, comorbid bronchiectasis, comorbid hepatitis B virus infection, elevated C-reactive protein, extrapulmonary tuberculosis, CD4⁺ T lymphocyte count, and hemoglobin levels(P<0.05). Multivariate logistic regression analysis showed that drug resistant tuberculosis, comorbid bronchiectasis, comorbid hepatitis B virus infection, elevated C-reactive protein, and extrapulmonary tuberculosis were risk factors for pulmonary co-infections in AIDS with PTB, while antiretroviral therapy, higher CD4⁺ T lymphocyte count, and higher hemoglobin were protective factors(P<0.05). Conclusion Patients with AIDS and PTB primarily present with fever, fatigue and weight loss, and often have pulmonary co-infections, hypoproteinemia, electrolyte disturbances and anemia. The imaging features also differ significantly from those of patients with PTB alone. Drug-resistant tuberculosis, comorbid bronchiectasis, comorbid hepatitis B virus infection, elevated C-reactive protein, and extrapulmonary tuberculosis are risk factors for pulmonary co-infections in such patients, while antiretroviral therapy, higher CD4⁺ T-lymphocyte count, and higher hemoglobin levels serve as protective factors.