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[结核病与艾滋病毒感染——主要诊断和治疗问题]

[Tuberculosis and HIV infection--main diagnostic and therapeutic problems].

作者信息

Dabrowska Magdalena M, Pogorzelska Joanna, Parfieniuk Anna, Siwak Ewa, Wiercińska-Drapało Alicja

机构信息

Akademia Medyczna w Białymstoku, Klinika Obserwacyjno-Zakaźna.

出版信息

Pol Merkur Lekarski. 2007 Sep;23(135):212-4.

Abstract

Tuberculosis pertains to every third HIV-positive person in a world. Therefore HIV infection is considered the most evident risk factor for the primary tuberculosis or relapse of latent tubercular infection. Pulmonary tuberculosis is the most frequent clinical presentation in HIV-positive individuals, although the frequency of extrapulmonary tuberculosis is increasing with the CD4+ count reduction. Tuberculin skin testing and bacteriological tests are regarded as a "gold standard" of diagnosis. Molecular diagnostics and evaluation of a whole-blood interferon-gamma release assay for the detection of Mycobacterium tuberculosis are not cost-effective therefore their application is limited. DOTS programs are recommended for the antimycobacterial treatment in HIV-infected patients. The increasing drug resistance of Mycobacterium tuberculosis (multi-drug resistant tuberculosis--MDRTB) is emerging problem in the field of tuberculosis management.

摘要

在全球范围内,每三名艾滋病毒呈阳性的人中就有一人患有结核病。因此,艾滋病毒感染被认为是原发性结核病或潜伏性结核感染复发最明显的危险因素。肺结核是艾滋病毒呈阳性个体中最常见的临床表现,尽管随着CD4+细胞计数的减少,肺外结核的发生率在增加。结核菌素皮肤试验和细菌学检测被视为诊断的“金标准”。用于检测结核分枝杆菌的分子诊断和全血干扰素-γ释放试验评估不具有成本效益,因此其应用受到限制。建议采用直接观察短程疗法(DOTS)对艾滋病毒感染患者进行抗分枝杆菌治疗。结核分枝杆菌耐药性的不断增加(耐多药结核病——MDRTB)是结核病管理领域中出现的一个问题。

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