Liu Yan, Yu Wei-Ye, Lu Pu-Xuan, Liu Ying-Xia, Yao Si-Min, Cai Xiong-Mao, Xue Hai-Zhen
Department of Infectious Diseases, Third People's Hospital of Shenzhen, Guangdong 518020, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2009 Nov;32(11):835-7.
To study the clinical features of acquired immune deficiency syndrome (AIDS) complicated with tuberculosis of mesenteric lymph nodes.
Cases (n = 153) with AIDS complicated with tuberculosis hospitalized in this hospital from September 1999 to December 2008 were retrospectively analyzed. Mesenteric lymph node tuberculosis was found in 11 cases, including 7 males and 4 females. One patient was 8 years old, and the other 10 were over 22 years (ranging from 8 to 55 years).
In patients with AIDS complicated with tuberculosis, 7% (11/158) had tuberculosis of the mesenteric lymph nodes. The CD(4)(+) cell count was less than 50 x 10(6) cells/L in 8 cases, and (50 - 100) x 10(6) cells/L in 3 cases. The symptoms included fever (11/11), abdominal pain (11/11), abdominal distension (11/11), night sweat (7/11), weight loss (10/11), diarrhea (7/11), anemia (5/11), abdominal mass (3/11), and ascites (1/11). Abdominal ultrasound showed multiple enlarged mesenteric lymph nodes in all of the 11 cases, and abdominal CT scanning presented typical enhanced ring shadows. Biopsy of mesenteric lymph nodes was obtained from 2 cases, and both revealed tuberculoma, caseous necrosis. Longerhan cell infiltration, and positive stain for fast anti-acid bacilli. Enlarged mesenteric lymph nodes became smaller and disappeared after treatment with antituberculous drugs for 6 months and highly active antiretroviral therapy (HAART) for 5 months in all the 11 patients.
There were no specific clinical manifestations in AIDS patients with tuberculosis of mesenteric lymph nodes. However, AIDS patients with CD(4)(+) cell count less than 50 x 10(6) cells/L might be more prone to developing tuberculosis of the mesenteric lymph nodes. Abdominal CT scanning with typical strengthened ring shadow is suggestive of the diagnosis. Anti-tuberculous therapy combined with HAART is recommended for the treatment of patients with suspected tuberculosis.
研究获得性免疫缺陷综合征（艾滋病）合并肠系膜淋巴结结核的临床特征。
回顾性分析1999年9月至2008年12月在本院住院的153例艾滋病合并结核病患者。其中发现肠系膜淋巴结结核11例，男性7例，女性4例。1例患者8岁，其余10例年龄超过22岁（年龄范围8至55岁）。
在艾滋病合并结核病患者中，7%（11/158）有肠系膜淋巴结结核。8例患者的CD4(+)细胞计数低于50×10(6)/L，3例患者的CD4(+)细胞计数为（50 - 100）×10(6)/L。症状包括发热（11/11）、腹痛（11/11）、腹胀（11/11）、盗汗（7/11）、体重减轻（10/11）、腹泻（7/11）、贫血（5/11）、腹部肿块（3/11）和腹水（1/11）。腹部超声显示11例患者均有多个肠系膜淋巴结肿大，腹部CT扫描呈现典型的强化环形阴影。对2例患者进行了肠系膜淋巴结活检，均显示结核瘤、干酪样坏死、朗汉斯细胞浸润及抗酸杆菌快速染色阳性。11例患者经抗结核药物治疗6个月及高效抗逆转录病毒治疗（HAART）5个月后，肿大的肠系膜淋巴结均缩小并消失。
艾滋病合并肠系膜淋巴结结核患者无特异性临床表现。然而，CD4(+)细胞计数低于50×10(6)/L的艾滋病患者可能更容易发生肠系膜淋巴结结核。腹部CT扫描出现典型强化环形阴影提示诊断。对于疑似结核病患者，建议采用抗结核治疗联合HAART进行治疗。
