坦桑尼亚达累斯萨拉姆市穆希姆比利国家医院收治患者中的结核病与艾滋病病毒合并感染情况。

Tuberculosis-HIV co-infection among patients admitted at Muhimbili National Hospital in Dar es salaam, Tanzania.

作者信息

Kamenju Pili, Aboud Said

机构信息

School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.

Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.

出版信息

Tanzan J Health Res. 2011 Jan;13(1):21-6. doi: 10.4314/thrb.v13i1.60682.

DOI:10.4314/thrb.v13i1.60682

PMID:24409643

Abstract

Data on the clinical presentations and magnitude of tuberculosis (TB)-human immunodeficiency virus (HIV) co-infection is limited. The objective of this study was to describe the clinical presentation and prevalence of TB-HIV co-infection among patients admitted at Muhimbili National Hospital between August 2008 and July 2009 in Dar es Salaam, Tanzania. Of 387 TB patients included, 117 (30.2%) were in the age group 30-39 years. The overall mean age of patients was 38.1 years (range 8 to 86 years) and 216 (55.8%) were male. Two hundred and five (53%) had pulmonary tuberculosis (PTB), 58 (15%) had extra pulmonary tuberculosis (EPTB) and 124 (32%) had both PTB and EPTB. Common sites of EPTB were pleural cavity 80 (44%), lymph node 31 (17%) and 30 (16.5%) abdomen. Of the 300 TB patients tested for HIV, 175 (58.3%) were HIV-infected and 97 (55.4%) of these were already on antiretroviral therapy (ART) at time of admission. Overall, 104 (26.9%) of the TB patients admitted died. About two thirds of patients who died had PTB. About three quarters (73.1%; N=283) of the patients were discharged home to continue with anti-TB treatment. There was significantly higher proportion of deaths among HIV-infected TB patients (29.1% versus 15.2%) than in the HIV uninfected TB patients (P=0.005). Age was a significant predictor for PTB (OR 0.946, 95% CI 0.917-0.976) while age (OR 1.019, 95% CI 1.002-1.036) and HIV serostatus (OR 2.143, 95% CI 1.313-3.497) were significant risk factors for EPTB. It is concluded that more than half of the patients had PTB and pleural cavity was the most common site of EPTB. TB-HIV co-infected patients had significantly higher mortality than the TB-HIV- uninfected patients. It is recommended to emphasize on the provision of HIV counselling and testing to all TB patients to ensure proper management and timely initiation of ART in TB-HIV co-infected patients in order to improve the outcome and reduce mortality.

摘要

关于结核病（TB）与人类免疫缺陷病毒（HIV）合并感染的临床表现及严重程度的数据有限。本研究的目的是描述2008年8月至2009年7月期间在坦桑尼亚达累斯萨拉姆的穆希姆比利国家医院住院的患者中，TB-HIV合并感染的临床表现及患病率。在纳入的387例结核病患者中，117例（30.2%）年龄在30 - 39岁之间。患者的总体平均年龄为38.1岁（范围8至86岁），男性216例（55.8%）。205例（53%）患有肺结核（PTB），58例（15%）患有肺外结核（EPTB），124例（32%）同时患有PTB和EPTB。EPTB的常见部位为胸腔80例（44%）、淋巴结31例（17%）和腹部30例（16.5%）。在300例接受HIV检测的结核病患者中，175例（58.3%）感染了HIV，其中97例（55.4%）在入院时已接受抗逆转录病毒治疗（ART）。总体而言，入院的结核病患者中有104例（26.9%）死亡。死亡患者中约三分之二患有PTB。约四分之三（73.1%；N = 283）的患者出院回家继续接受抗结核治疗。HIV感染的结核病患者的死亡比例（29.1%对15.2%）显著高于未感染HIV的结核病患者（P = 0.005）。年龄是PTB的显著预测因素（OR 0.946，95% CI 0.917 - 0.976），而年龄（OR 1.019，95% CI 1.002 - 1.036）和HIV血清学状态（OR 2.143，95% CI 1.313 - 3.497）是EPTB的显著危险因素。得出的结论是，超过一半的患者患有PTB，胸腔是EPTB最常见的部位。TB-HIV合并感染的患者的死亡率显著高于未合并感染的患者。建议强调为所有结核病患者提供HIV咨询和检测，以确保对TB-HIV合并感染的患者进行妥善管理并及时启动ART，从而改善治疗结果并降低死亡率。