中国社区医师
中國社區醫師
중국사구의사
Chinese Community Doctors
2014年
34期
32-33
,共2页
艾滋病%合并%肺结核%临床特点%治疗和转归
艾滋病%閤併%肺結覈%臨床特點%治療和轉歸
애자병%합병%폐결핵%림상특점%치료화전귀
Aids%Merge%Pulmonary tuberculosis%Clinical characteristics%Treatment and prognosis
目的：进一步了解艾滋病合并肺结核患者的临床特点和提高本病的诊治水平。方法：2012年1月-2013年3月收治艾滋病合并肺结核双重感染患者20例，对其一般资料、临床症状、影像学检查情况、实验室检查以及治疗和转归等资料进行整理并研究分析。结果：20例患者中，男19例(95%)，女1例(5%)；年龄4～73岁，＜20岁2例(10%)，21～30岁1例(5%)，＞31岁17例(85%)；浸润型肺结核17例(85%)，粟粒型肺结核3例(15%)，合并胸膜炎2例(10%)；痰菌阳性3例(15%)，阴性15例(75%)，未痰检2例(10%)；涂阴重症(空洞型)3例(15%)。治疗方案：采用2H3R3Z3E3/4H3R3方案4例(20%)，采用2HRZE/4HR 方案14例(70%)，2例合并结核性胸膜炎的患者采用2HEZE/10HRE方案，2例(10%)低龄患者根据具体情况给予个体化方案；转归情况：6个月疗程结束后，治愈2例(10%)，完成疗程11例(55%)，死亡5例(25%)，未好转2例(10%)(中断治疗)。结论：艾滋病合并肺结核患者男青壮年居多，由于免疫力极度低下，易合并其他感染，故临床症状不典型，影像学检查表现形式多样，空洞不多见，痰菌阳性率低，患者因不能耐受药物不良反应容易中断治疗，死亡率高，治愈率低。因此把握好艾滋病合并肺结核患者的治疗时机，进一步加强对患者的督导管理和及时正确处理药物不良反应将提高患者的依从性，从而改善患者的生存质量。
目的：進一步瞭解艾滋病閤併肺結覈患者的臨床特點和提高本病的診治水平。方法：2012年1月-2013年3月收治艾滋病閤併肺結覈雙重感染患者20例，對其一般資料、臨床癥狀、影像學檢查情況、實驗室檢查以及治療和轉歸等資料進行整理併研究分析。結果：20例患者中，男19例(95%)，女1例(5%)；年齡4～73歲，＜20歲2例(10%)，21～30歲1例(5%)，＞31歲17例(85%)；浸潤型肺結覈17例(85%)，粟粒型肺結覈3例(15%)，閤併胸膜炎2例(10%)；痰菌暘性3例(15%)，陰性15例(75%)，未痰檢2例(10%)；塗陰重癥(空洞型)3例(15%)。治療方案：採用2H3R3Z3E3/4H3R3方案4例(20%)，採用2HRZE/4HR 方案14例(70%)，2例閤併結覈性胸膜炎的患者採用2HEZE/10HRE方案，2例(10%)低齡患者根據具體情況給予箇體化方案；轉歸情況：6箇月療程結束後，治愈2例(10%)，完成療程11例(55%)，死亡5例(25%)，未好轉2例(10%)(中斷治療)。結論：艾滋病閤併肺結覈患者男青壯年居多，由于免疫力極度低下，易閤併其他感染，故臨床癥狀不典型，影像學檢查錶現形式多樣，空洞不多見，痰菌暘性率低，患者因不能耐受藥物不良反應容易中斷治療，死亡率高，治愈率低。因此把握好艾滋病閤併肺結覈患者的治療時機，進一步加彊對患者的督導管理和及時正確處理藥物不良反應將提高患者的依從性，從而改善患者的生存質量。
목적：진일보료해애자병합병폐결핵환자적림상특점화제고본병적진치수평。방법：2012년1월-2013년3월수치애자병합병폐결핵쌍중감염환자20례，대기일반자료、림상증상、영상학검사정황、실험실검사이급치료화전귀등자료진행정리병연구분석。결과：20례환자중，남19례(95%)，녀1례(5%)；년령4～73세，＜20세2례(10%)，21～30세1례(5%)，＞31세17례(85%)；침윤형폐결핵17례(85%)，속립형폐결핵3례(15%)，합병흉막염2례(10%)；담균양성3례(15%)，음성15례(75%)，미담검2례(10%)；도음중증(공동형)3례(15%)。치료방안：채용2H3R3Z3E3/4H3R3방안4례(20%)，채용2HRZE/4HR 방안14례(70%)，2례합병결핵성흉막염적환자채용2HEZE/10HRE방안，2례(10%)저령환자근거구체정황급여개체화방안；전귀정황：6개월료정결속후，치유2례(10%)，완성료정11례(55%)，사망5례(25%)，미호전2례(10%)(중단치료)。결론：애자병합병폐결핵환자남청장년거다，유우면역력겁도저하，역합병기타감염，고림상증상불전형，영상학검사표현형식다양，공동불다견，담균양성솔저，환자인불능내수약물불량반응용역중단치료，사망솔고，치유솔저。인차파악호애자병합병폐결핵환자적치료시궤，진일보가강대환자적독도관리화급시정학처리약물불량반응장제고환자적의종성，종이개선환자적생존질량。
Objective:To further understand clinical features of patients with AIDS complicated with pulmonary tuberculosis,and to improve the level of diagnosis and treatment for this disease.Methods:20 patients with AIDS complicated with pulmonary tuberculosis were selected from January 2012 to March 2013,then collated and analyzed their general data,clinical symptoms and imaging,as well as their laboratory examination,treatment methods and outcome.Results:Among those 20 patients,there were 19 cases of male(95%),1 cases of female(5%);they were aged 4~73 years old,with 2 cases less than 20 years old(10%),1 cases 21~30 years old(5%),and 18 cases over 31 years old(85%);17 cases with infiltrative pulmonary tuberculosis(85%) and 3 patients with miliary pulmonary tuberculosis(15% ),while 2 cases were complicated with pleurisy(10% );the sputum was positive in 3 patients(15%),15 cases were negative(75%),and 2 cases did not taken sputum exam(10%);there were 3 cases with smear negative myasthenia(cavity) (15% ).Treatment:There were 4 cases(20% ) taken 2H3R3Z3E3/4H3R3,12 cases(70% ) with 2HRZE/4HR,2 cases with tuberculous pleurisy were treated with 2HEZE/10HRE regimen,2 young patients(10%) were given individualized plan according to the specific situation.Prognosis:the treatment last for 6 month,when the treatment ended,2 cases were cured(10%),11 cases(55% ) were completed the course of treatment,moreover,there were 5 cases(25% ) dead,and 2 cases(10% ) had no improvement because of treatment interruption.Conclusion:The majority of patients with AIDS complicated with pulmonary tuberculosis are among young men,because of their extremely low immunity,so those patients can be easily complicated with other infections,so their clinical symptoms are not typical,and imaging examination in a variety of forms,the empty usually can not be see,while sputum positive rate is low,patients easy to interrupt treatment because of cannot tolerate the adverse reaction of drugs, so the mortality rate is high and the cure rate is low among those patients.Therefore,we should grasp a good opportunity of treatment in patients with AIDS complicated with pulmonary tuberculosis,to strengthen the supervision and management further, and treat the adverse reactions of drug correctly and timely,so it will improve the compliance of patients,thereby improving the quality of patients' life.
