关键词: 结核,脊柱, HIV感染, 共病现象, 疾病特征, 对比研究

Abstract:

Objective To analyze the disease characteristics of HIV-positive spinal tuberculosis patients and the effect of strengthening perioperative management. Methods Using retrospective analysis, 23 cases of HIV-positive spinal tuberculosis treated in Chengdu Public Health Clinical Medical Center from January 2014 to January 2018 were enrolled as HIV-positive group, 316 cases of HIV-negative spinal tuberculosis treated in the same period were used as control group. Measurement data was expressed as “ \bar{x} ±s”, comparison between groups was tested by t test; categorical data was expressed as “rate (or composition ratio)”, comparison between groups was tested using χ ², statistically significance was set at P<0.05. Results HIV positive group, PPD test positive rate was 21.7% (5/23), tuberculosis infected T cell spot test positive rate was 47.8% (11/23), tuberculosis antibody test positive rate was 13.0% (3/23), sputum smear acid-fast bacillus test positive rate was 4.3% (1/23), the incidence of concurrent pulmonary tuberculosis was 21.7% (5/23), the typical imaging of spinal tuberculosis were 43.5% (10/23), and the incidence of typical tuberculosis symptoms was 13.0% (3/23), which were lower than the control group (81.0% (256/316), 84.8% (268/316), 28.2% (89/316), 21.2% (67/316), 60.8% (192/316), 82.0% (259/316), 58.9% (186/316)). Except for the positive rate of tuberculosis antibody and sputum smear showed no significant difference (χ ²=42.42, 21.75, P=0.115, 0.051), all others were statistically significant (χ ²=204.99, 232.23, 142.52, 220.68, 132.16, P=0.000). The percentage of patients with CD4 ⁺ T lymphocyte count <350 cells/μl among HIV-positive group was 82.6% (19/23), which was higher than the control group (20.6% (65/316)). The difference was statistically significant (χ ²=52.17, P=0.000). After intensive perioperative management in the HIV-positive group, CD4 ⁺ T lymphocyte counts and serum albumin quantifications, and hemoglobin amounts were (285.17±23.04)/μl, (40.44±0.37) g/L, (129.30±1.72) g/L, getting improved from before implementing intensive perioperative management ((219.83±26.56) pcs/μl, (29.51±0.94) g/L, (97.48±3.16) g/L),the difference was statistically significant (t=-6.804, -10.977, -8.318, P=0.000). The body mass index before and after enhancing perioperative management were 20.84±0.29, 20.85±0.29 respectively, the difference was not statistically significant (t=-0.541, P=0.594). In the HIV-positive group, the drug resistance rate, liver damage rate, tuberculosis unhealed rate, and long-term mortality were 30.4% (7/23), 65.2% (15/23), 8.7% (2/23), 8.7% (2/23), which were higher than the control group (13.0% (41/316), 34.5% (109/316), 0.9% (3/316), 0.6% (2/316)), the differences were statistically significant (χ ²=10.11, 37.71, 15.04, 17.39, P=0.020, 0.006, 0.003, 0.001). Conclusion Most of the clinical test results of HIV-positive spinal tuberculosis patients are worse than those of patients with HIV-negative spinal tuberculosis. By strengthening the perioperative management, the immunological and nutritional indicators of patients have improved.

Key words: Tuberculosis,spine, HIV infections, Comorbidity, Disease characteristics, Comparative study