关键词: 结核, HIV感染, 共病现象, 外科手术, T淋巴细胞

Abstract:

Objective: To systematically evaluate the clinical indicators of patients with tuberculosis complicated by HIV/AIDS undergoing surgical treatment based on CD4⁺ T lymphocyte levels, analyze the changes in clinical and immunological indicators during long-term postoperative follow-up, and explore the factors influencing surgical efficacy and prognosis in this population. Methods: A retrospective study was conducted to collect the medical records of 59 patients with tuberculosis complicated by HIV/AIDS who underwent surgical treatment at Guangxi Zhuang Autonomous Region Chest Hospital from January 2017 to January 2023. The subjects were divided into the observation group (CD4⁺ T lymphocyte count <200 cells/μl, n=41) and the control group (CD4⁺ T lymphocyte count ≥200 cells/μl, n=18) according to preoperative CD4⁺ T lymphocyte counts. Preoperative general demographic characteristics, laboratory test indicators, as well as blood routine, liver and kidney function, immune function indicators and incision healing status at postoperative day 7, day 14, month 12 and month 24 were collected and compared between the two groups. Results: The proportion of non-tuberculous focus debridement in the observation group was 90.24% (37/41), significantly higher than 66.67% (12/18) in the control group; the proportion of grade Ⅰ/Ⅱ surgeries was 48.78% (20/41), significantly higher than 16.67% (3/18) in the control group; and the proportion of class Ⅰ incisions was 70.73% (29/41), significantly higher than 27.78% (5/18) in the control group, with statistically significant differences (χ²=4.940, 5.423, 11.763, all P<0.05). All subjects had poor preoperative nutritional status, with an abnormal hemoglobin rate of 71.19% (42/59) and an abnormal albumin rate of 66.10% (39/59). At 7 days postoperatively, the good incision healing rate was 72.88% (43/59), including 67.44% (29/43) in the observation group and 32.56% (14/43) in the control group; the poor incision healing rate was 27.12% (16/59), including 75.00% (12/16) in the observation group and 25.00% (4/16) in the control group. There was no statistically significant difference in incision healing status between the two groups at 7 days postoperatively (χ²=0.314, P=0.575). At 14 days postoperatively, only 4 subjects still had poor incision healing; at 28 days postoperatively, all incisions were completely healed, and no opportunistic infections or complications occurred during the entire period. During different postoperative follow-up periods, the abnormal rates of red blood cell count (${\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^{2}$=9.692, P=0.002), white blood cell count (${\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^{2}$=17.307, P<0.001), hemoglobin level (${\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^{2}$=59.736, P<0.001), platelet count (${\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^{2}$=9.637, P<0.001), aspartate aminotransferase level (${\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^{2}$=12.320, P<0.001), total bilirubin level (${\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^{2}$=5.494, P=0.019), direct bilirubin level (${\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^{2}$=9.705, P=0.002) and albumin level (${\chi }_{\mathrm{t}\mathrm{r}\mathrm{e}\mathrm{n}\mathrm{d}}^{2}$=61.494, P<0.001) all showed a significant linear downward trend. Conclusion: The postoperative clinical recovery of patients with tuberculosis complicated by HIV/AIDS undergoing surgical treatment is closely related to their nutritional status, liver and kidney function, incision healing status and immune function. CD4⁺ T lymphocyte count <200 cells/μl is not an absolute contraindication to surgical treatment in this population. For patients scheduled for surgery with CD4⁺ T lymphocyte count <200 cells/μl, perioperative complication management should be completed under the guidance of infectious disease specialists, and surgery should be performed after comprehensive evaluation.

Key words: Tuberculosis, HIV infections, Comorbidity, Surgical procedures, operative, T-lymphocytes