Analysis Of Clinical Characteristics And Laboratory Results Of Aids Complicated With Tuberculosis

Objective To analyze the clinical characteristics of AIDS complicated with tuberculosis,and to evaluate the application of different detection methods(etiology,immunology,molecular biology)in the diagnosis of tuberculosis.Methods A total of 130 AIDS patients with pulmonary tuberculosis and 146 patients with simple pulmonary tuberculosis admitted to Yunnan Infectious Diseases Hospital from January 2020 to January 2022 were selected.The clinical data and results of etiology,immunology and molecular biology of the two groups were analyzed.Results 1.The TB group had a higher history of previous TB and diabetes than the AIDS-TB group,and the comparison of the two groups was found to be statistically significant.(P < 0.05).Extrapulmonary tuberculosis,fungal infection and hypoproteinemia were common in AIDS/TB group,and the difference between the two groups was statistically significant(P < 0.05).2.The proportion of drug-resistant TB patients in the TB group was 17.1%,which was significantly higher than the 7.7% in the AIDS-TB group,with a statistically significant difference(P<0.05).Among the types of pulmonary TB,the number of hematogenous disseminated TB was significantly lower in the TB group(0.7%)than in the AIDS-TB group(5.4%),with a statistically significant difference(P<0.05),while there was no statistically significant difference between the two groups of patients with secondary TB and other types of TB(tracheobronchial TB,tuberculous pleurisy).The type of concurrent extrapulmonary TB was higher in the AIDS-TB group than in the TB group,with a statistically significant difference(P<0.05),while the difference between lymph node TB and other types of TB(intestinal TB,bone TB,urinary TB,etc.)was not statistically significant.3.In the AIDS-TB group,58.49% of febrile patients had a temperature greater than39°C,which was significantly higher than the 16.21% in the TB group,with a difference of statistical significance(P < 0.05),whereas in the AIDS-TB group,16.98% had a febrile temperature of 38-39°C,which was clearly lower than the 44.74% in the TB group with a statistically significant difference(P < 0.05).There was no statistically significant difference between the two groups of febrile patients with body temperature 37-38°C(P> 0.05),see Table 2.The percentage of cough patients in the TB group with cough duration >8 weeks was52.42%,which was significantly higher than that in the AIDS-TB group,and the difference was found to be statistically significant(P < 0.05).In addition,coughing and hemoptysis were more common in the AIDS-TB group than in the TB group.In the AIDS-TB group,the positive rates of the three tests were 42.3%(55/130)for TSPOT,34.6%(45/130)for sputum smear,and 51.5%(67/130)for Gene Xpert MTB/RIF;in the TB group,the positive rates of the three tests were 64.4%(94/146)for T-SPOT,50.7%(74/146)for sputum smear,and 69.2%(101/146)for Gene Xpert MTB/RIF.The positive rates of all three assays in the TB group were higher than those in the AIDS-TB group and showed statistical differences(P < 0.05).By χ2 test analysis,the positive rate of Gene Xpert MTB/RIF was higher than that of sputum smear and T-SPOT in the TB group and statistically different(χ2 value=11.350,P=0.003),while in the AIDS-TB group,the positive rate of Gene Xpert was higher than that of sputum smear compared with the positive rate,but the difference was not found to be statistically significant(χ2 value= 7.624,P=0.027).4.The difference in the CD4+/CD8+ ratio between the two groups was statistically significant(P < 0.05),and the CD4+/CD8+ ratio in the AIDS-TB group was inverted,while the CD4+/CD8+ ratio in the TB group was in the normal range.The difference was statistically significant(P < 0.05)in the comparison of CD4+ T cells in both groups TB group was higher than AIDS-TB group,but the level of CD4+ T lymphocytes in both groups was below the normal range,while the difference between the two groups in the comparison of CD8+ T cells was not statistically significant(P > 0.05).Conclusion 1.Patients with AIDS and pulmonary tuberculosis are more likely to form hematogenous disseminated tuberculosis and extrapulmonary tuberculosis,and fungal infections are more likely to form fungal sepsis.2.The clinical manifestations of AIDS patients with tuberculosis are not typical,with rapid onset and rapid disease progression.The fever is often high fever,which is inconsistent with the afternoon hot flash of tuberculosis.3.In this study,the sputum Gene Xpert MTB/RIF test has a higher positive rate in HIV/AIDS complicated with tuberculosis,and has better diagnostic value compared with other detection methods.4.Lymphocytes play an important role in tuberculosis immunity.Studies have shown that cellular immune function is significantly decreased in patients with retreatment or extrapulmonary tuberculosis,and the ratio of CD4+T lymphocytes and CD4+/CD8+ is correlated with disease progression,which is an important reference for disease prognosis.