The Comparison Of Clinical Characteristics Between HIV/AIDS Combined TB And Pure Tuberculosis And Its Long-term Variation Characteristics And Trends

ObjectiveAIDS (AIDS) patients complicated with tuberculosis is one of the most common opportunistic infection with high fatality rate, and TB is the leading cause of death among people infected with HIV. Along with the increasing serivity of HIV infection epidemic, HIV/AIDS and TB infection at the same time had become the focus and difficulty in clinical diagnosis and treatment, prevention and control. This research used the retrospective comparative analysis of t clinical data of HIV/AIDS combined TB and pure TB patients in recent10years, and explore the clinical features of patients with HIV/AIDS combined TB and its long-term variation characteristics and trends, in order to provide the basis for accurate diagnosis and timely treatment of patients for HIV/AIDS combined TB,and to provide theoretical basis for the establishment of TB prevention and control measures.MethodsAll the samples are collected from the patients attending the fourth Hospital of Shanxi Medical University from April2004to December2013.Total224patients includes75cases who were diagnosed as HIV/AIDS combined TB patients and149pure TB patients. Relevant information of subjects was collected through structural questionnaire including demographic characteristics, clinical symptoms, course and hospitalization days, auxiliary examination such as imaging features of iconography sputum smear、tuberculin test、n/med tuberculosis bacterium tuberculosis antibody protein chipLAM, the value of ESR, CD4, CD8, CD3as well as routes of transmission of HIV/AIDS. The data were analyzed by SPSS17.0. The continuous variables were examined by wilcoxon rank sum test, and the categorical variables were examined using the x2test and x2trend test, the inspection level:α=0.05.Results1. Demographic characteristics analysis shows the distribution of age, sex, smoking, residence, and cultural level in two groups have no statistics difference (P>0.05), but the distribution of occupation, marital status and nationality had statistically significance (P<0.05). Patients who were diagnosed as HIV/AIDS combined TB were more farmers (49.3%), more divorced, unmarried, and minorities.2. Pure TB patients diagnosed as tuberculosis has the highest positive rate (66.4%), followed by tuberculosis pleurisy (34.9%) and other diagnosis (16.1%), HIV/AIDS combined TB patients diagnosed as tuberculosis positive rate is the highest (64.0%), followed by lymphatic tuberculosis (21.6%) and tuberculosis pleurisy (20.0%), two groups of subjects in the diagnosis of tuberculosis pleurisy and lymphatic tuberculosis positive rate was statistically difference (P<0.05), have been found pulmonary tuberculosis, bone tuberculosis, tuberculosis meningitis, serous cavity effusion, and other diagnostic distribution between the two groups was statistically difference.3.The incidence of HIV/AIDS combined TB patients’ clinical symptoms such as fever, fatigue, poor appetite, marasmus were higher than the pure TB patients, the incidence of chest pain is lower than the pure TB patients, and the difference were statistically significant (P<0.05), two groups of patients with clinical symptoms of cough, shortness of breath, there was no statistically significant difference in the incidence of night sweats. The incidence of complications in HIV/AIDS combined TB was higher than pure TB patients, mainly in the following five aspects such as anemia, electrolyte disorder, hypoalbuminemia, fungal infection and pulmonary infection this five aspects (P<0.05).4. The immunological detection in112cases of pure TB patients and60patients of HIV/AIDS combined TB, the result showed:HIV/AIDS combined TB blood enzymatic detection rate of positive anti-body tuberculosis (14.7%) was higher than pure TB patients test positive rate (10.1%), and blood tuberculosis antibody protein microarray method (LAM), and the positive rate of38KD and PPD test were lower than pure TB patients, in addition the difference was statistically significant (P<0.05), while16KD detection had no statistical significance.5. CT detection in114pure TB patients and49HIV/AIDS combined TB patients, the result showed the incidence of left lung CT examination showed pure TB patients (79.8%), and cavity rate (29.8%) were higher than HIV/AIDS (65.3%、14.3%) combined TB, and the rate of mediastina lymphadenectasis(31.6%) was lowers than HIV/AIDS combined TB patients (71.4%), the differences were statistically significant (P<0.05); The right pulmonary tuberculosis in pure TB patients and HIV/AIDS with TB patients (78.1%、83.7%), upper lobe (81.6%、77.6%), middle (74.6%、71.4%), lower lobe (57.9%、61.2%), and the incidence of pleural effusion (40.4%、30.6%) no statistical difference but the difference had no statistical significance (P>0.05).6. In40HIV/AIDS combined tuberculosis patients, sputum smear acid fast bacilli detection positive rate (40.0%) was higher than that of93pure TB patients sputum smear positive rate (31.2%), but the difference between the two groups had no statistical significance (P>0.05).Blood sedimentation value of the149HIV/AIDS combined TB patients (72±50) mm/h was higher than75pure TB patients (28±46) mm/h, the difference had statistical significance (P<0.05). 7. The course and hospitalization days of HIV/AIDS combined TB patients were longer than the pure TB patients, the difference was statistically significant (P<0.05), but the rate of treatment improvement in HIV/AIDS combined tuberculosis (89.3%) and pure TB patients (94.5%) was almost the same, but the difference had no statistical difference.8.This study showed the value of CD4/CD8/CD3cell in the had no statistical difference in five time series; we still doubt the relationship between CD4cell count and clinical diagnosis、radiographic features、and treatment of complications existed statistical correlation (P>0.05). In2004～2013HIV/AIDS with TB patients’main clinical symptoms like fever, fatigue, shortness of breath, chest pain, poor appetite, night sweats, angular rate had no significant variation tendency, while the cough rate decreased with statistical significance (x2trend=5.25, P=0.022), and clinical diagnosis of pulmonary tuberculosis, pleurisy, lymphoid tuberculosis diagnosis positive rate is very high, but the diagnosis of tuberculosis positive rate showed a trend of decrease, lymphoid tuberculosis diagnosis positive rate showed an increasing trend with statistical significance (x2trend=6.00, P=0.014; x2trend=10.01, P=0.002), and other diagnostic positive rate did not see any obvious variation tendency.9.This study found that from2004to2013HTV/AIDS combined TB patients blood transmission and sexual transmission were the main transmission route, among them, blood transmission showed a downward trend, sexual transmission was on the rise, and this variation tendency had statistical significance (P<0.05); HIV/AIDS combined TB patients was more concentrated in the age of21～40years old, mainly happens in men than in women from2004to2013. Conclusion1. The farmers, divorced, unmarried, and ethnic minorities are HIV/AIDS combined TB patient high-risk groups. 2. The rate of pulmonary tuberculosis was the most common diagnosis in two groups, followed by tuberculosis pleurisy in pure TB patients and lymphatic tuberculosis in HIV/AIDS combined TB. The clinical symptoms such as fever, fatigue, poor appetite, angular in HIV/AIDS combined TB patients were higher than pure TB patients, patients with HIV/AIDS combined TB had the tendency of chronic diseases. The immunological indexes such as blood tuberculosis antibody protein microarray method (LAM),38KD and PPD test positive rate HIV/AIDS combined TB patients were lower than that of pure TB patients. CT examination showed simple TB patients was easier happened in the left lung, and prone to hollow, and meditational lymph node enlargement rate lower than that of HIV/AIDS combined TB patients. HIV/AIDS combined tuberculosis patients and pure TB patients sputum smear acid fast bacilli detection positive rate was close, but the difference between the two groups had no statistical significance. HIV/AIDS combined TB patients blood sedimentation value is higher than pure TB patients. The hospitalization and the course of HIV/AIDS combined TB patients is longer than pure TB patients, but most the patients in two groups after treatment had improved.3.Among2004-2013, the positive rate of tuberculosis diagnosis and the cough rate decreased in HIV/AIDS combined tuberculosis patients showed a trend of decrease, lymphoid tuberculosis diagnosis positive rate showed a trend of increase, blood transmission and sexual transmission is the main way of infection, including blood spread a downward trend, sexual transmission is on the rise.