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目的了解HIV/AIDS人群中肺结核(HIV(+)TB(+))患者的免疫特征及抗结核治疗的效果。方法横断面收集12例现症HIV(+)TB(+)患者、24例HIV/TB双重感染者(HIV(+)PPD(+))、74例单纯HIV/AIDS患者(HIV(+)PPD(-))、56例单纯肺结核病患者(HIV(-)TB(+))(初治涂阳)及36例正常对照者的外周血2 ml,进行淋巴细胞亚群的比较。同时前瞻性收集12例HIV(+)TB(+)患者及56例HIV(-)TB(+)患者的血常规数据、药物不良反应的发生、痰菌阴转及肺部病变的改变进行抗结核治疗的效果分析。结果(1)与正常人群相比,HIV感染或结核感染均可导致患者的淋巴细胞亚群不同程度的下降(P<0.05)。(2)在HIV与结核双重感染人群的细胞免疫中,与HIV相关的免疫改变起主要作用:不管其是否结核发病,其淋巴细胞计数都存在同等程度的下降。(3)HIV(+)TB(+)患者的抗结核治疗效果较好:与HIV(-)TB(+)患者相比,药物不良反应、痰菌阴转及肺部病变的改变无显著性差异(P>0.05)。结论HIV(+)TB(+)患者的细胞免疫主要与HIV感染有关,而有效的抗结核药物治疗可提高HIV(+)TB(+)患者的细胞免疫功能,并可使其肺结核病得到良好的控制。
Objective To investigate the immunological characteristics of patients with HIV (+) TB (+) in HIV / AIDS population and the effect of anti-TB therapy. Methods Twelve cases of HIV (+) TB (+), 24 HIV / TB PPD (+) and 74 HIV / AIDS patients (HIV (+) PPD (-)) and 2 ml of peripheral blood from 56 patients with tuberculosis (HIV (-) TB (+)) (naive smear) and 36 normal controls. We also prospectively collected blood routine data from 12 patients with HIV (+) TB (+) and 56 patients with HIV (-) TB (+), the occurrence of adverse drug reactions, sputum negative conversion and pulmonary pathological changes Analysis of the effect of tuberculosis treatment. Results (1) Compared with the normal population, HIV infection or tuberculosis infection could lead to different degrees of lymphocyte subsets decline (P <0.05). (2) HIV-related immune changes play a major role in cellular immunity in HIV-infected and tuberculosis-infected populations: their lymphocyte counts decline to the same extent regardless of tuberculosis incidence. (3) The antituberculosis treatment was superior in HIV (+) TB (+) patients: there was no significant difference in ADRs, sputum negative conversion and pulmonary lesions compared with HIV (-) TB (+) patients Difference (P> 0.05). Conclusions The cellular immunity of HIV (+) TB (+) patients is mainly related to HIV infection. Effective anti-TB drug therapy can improve the cellular immune function of HIV (+) TB (+) patients and make their pulmonary tuberculosis well control.