关键词: 分枝杆菌, 结核, HIV, 重叠感染, 流行病学研究, 疾病特征

Abstract:

Objective To understand the epidemiology and clinical features of tuberculosis and HIV co-infected patients in Hunan province and provide a reliable reference for its prevention and treatment.Methods A total of 157 tuberculosis and HIV co-infected patients were enrolled from 2013 to 2017 in Hunan Chest Hospital, and 200 patients were selected from the non-HIV-infected tuberculosis patients as controls by stratified random sampling method. Data on the sociological characteristics, clinical features and results of laboratory tests were collected, and statistical analysis was conducted to identify the risk factors for tuberculosis complicated with HIV infection.Results Univariate analysis showed that male tuberculosis patients (125 cases, 79.6%), patients who aged 20-60 years old (20-39 years old: 55 (35.0%) cases; 40-60 years old: 79 (50.3%) cases, married patients (102 cases, 65.0%), patients who suffered from fever (70 cases, 44.6%), neck mass (31 cases, 19.7%), abdominal distension (9 cases, 5.7%), abdominal pain (10 cases, 6.4%) or lymphatic tuberculosis (50 cases, 31.8%), and patients complicated with syphilis infection (32 cases, 23.0%) were more likely infected with HIV. The differences were statistically significant (χ ² values were 7.55, 21.31, 15.06, 49.98, 15.70, 4.85, 5.95, 22.39, and 25.05; P values were 0.006, 0.000, 0.005, 0.000, 0.000, 0.028, 0.015, 0.000, and 0.000, respectively). The positive detection rates of tuberculosis antibody and tuberculosis infection T-cell spot test (T-SPOT.TB) in the double infection group (16.8% (25/149) and 61.7% (50/81)) were lower than those in the non-HIV-infected tuberculosis group (34.1% (60/176) and 78.2% (86/110)). The differences were statistically significant (χ ² values were 12.52 and 6.45; P values were 0.000 and 0.040, respectively). Multivariate analysis showed that among the TB patients, age of 20-39 and 40-60 were risk factors influencing the double infection of tuberculosis and HIV (the odds ratio (OR) (95%CI): 12.54 (1.53-102.89) and 9.09 (1.20-69.40)). The probability of clinical manifestations with fever, lymph node tuberculosis and syphilis in tuberculosis and HIV co-infected patients were higher, and the OR (95%CI) values were 6.51 (2.35-18.01), 5.80 (1.93-17.41) and 15.06 (2.71-83.84), respectively. The probability of bronchial tuberculosis in tuberculosis and HIV co-infected patients was lower (OR (95%CI): 0.03 (0.00-0.31)). Conclusion Tuberculosis patients aged 20-60 years are prone to be infected by HIV. The clinical manifestations with fever and lymph node tuberculosis are more common among tuberculosis and HIV co-infected patients.

Key words: Mycobacterium tuberculosis, HIV, Superinfection, Epidemiologic studies, Disease attributes