中国广西无症状 HIV+患者的肺结核诊断。

Diagnosis of pulmonary tuberculosis among asymptomatic HIV+ patients in Guangxi, China.

机构信息

Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Diseases Control and Prevention, Beijing 100050, China.

出版信息

Chin Med J (Engl). 2010 Dec;123(23):3400-5.

PMID:22166521

Abstract

BACKGROUND

Pulmonary tuberculosis (PTB) among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, risk factors and clinical outcomes of PTB among asymptomatic patients with HIV/AIDS in Guangxi to facilitate the development of diagnostic and treatment strategies.

METHODS

All asymptomatic adult HIV-infected patients with CD4 < 350 cells/µl who attended four HIV clinics in Guangxi between August 2006 and March 2008 were evaluated for active PTB with physical examination, chest X-ray (CXR), sputum smear and/or sputum liquid culture. Data were described using median (interquartile range, IQR) and frequencies. Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with PTB.

RESULTS

Among 340 asymptomatic subjects, 15 (4%) were diagnosed with PTB, with 4 (27%) sputum smear positive and 8 (53%) sputum culture positive. CXR has higher diagnostic sensitivity (87%) than sputum smear (25%) and sputum culture (67%), but lower specificity (56%) compared with sputum smear (99%) and culture (100%). In univariate analysis, injection drug user, body mass index (BMI) < 18 kg/m(2), CD4 < 50 cells/µl and presence of peripheral lymphadenopathy were associated with an increased risk of asymptomatic PTB, while in multivariate analysis only peripheral lymphadenopathy maintained statistical significance (OR = 7.6, 95%CI 1.4 - 40). Patients with negative smear and minor or no abnormalities on CXR had longer interval between screening and TB treatment.

CONCLUSIONS

PTB was relatively common in this group of HIV(+) asymptomatic Chinese patients. Diagnosis is challenging especially where sputum culture is unavailable. These findings suggest that an enhanced evaluation for PTB needs to be integrated with HIV care in China and transmission prevention in China to control at both households and health care facilities, especially for patients with factors associated with a higher risk of PTB.

摘要

背景

尽管中国结核病负担沉重，但针对无症状的 HIV 感染者中的肺结核（PTB），尚未开展相关研究。本研究旨在评估广西无症状 HIV/AIDS 患者中 PTB 的患病率、危险因素和临床结局，以便为诊断和治疗策略的制定提供依据。

方法

2006 年 8 月至 2008 年 3 月期间，对在广西四家 HIV 门诊就诊的 CD4<350 个细胞/µl 的所有无症状成年 HIV 感染者进行体格检查、胸部 X 线（CXR）、痰涂片和/或痰培养，以评估其是否患有活动性 PTB。使用中位数（四分位距，IQR）和频率来描述数据。采用单变量和多变量 Logistic 回归分析来确定与 PTB 相关的危险因素。

结果

在 340 例无症状患者中，有 15 例（4%）诊断为 PTB，其中 4 例（27%）痰涂片阳性，8 例（53%）痰培养阳性。CXR 的诊断敏感性（87%）高于痰涂片（25%）和痰培养（67%），但特异性（56%）低于痰涂片（99%）和培养（100%）。单变量分析显示，静脉吸毒、BMI<18kg/m²、CD4<50 个细胞/µl 和外周淋巴结肿大与无症状 PTB 风险增加相关，而多变量分析仅显示外周淋巴结肿大具有统计学意义（OR=7.6，95%CI 1.4-40）。痰涂片阴性且 CXR 显示轻微或无异常的患者从筛查到开始接受 TB 治疗的间隔时间较长。