摘要
目的比较人免疫缺陷病毒（HIV）抗体阴性与阳性者播散性马尔尼菲青霉菌病（PSM）临床及实验室特征。方法回顾性分析广西医科大学第一附属医院2002年3月至2007年3月确诊的33例PSM患者的临床资料。将33例分为HIV抗体阳性组：22例，男18例，女4例，年龄9～60岁，平均（39．5±4．4）岁；HIV抗体阴性组：11例，男8例，女3例，年龄（2～66岁），平均（45．1±4．6）岁。比较分析两组患者的特点。结果两组患者均以体力劳动者为主，临床均表现发热及多器官功能损害，以发热、肺部、皮肤、消化系统损害和淋巴结肿大为主，预后差。两组比较，有明显区别：（1）HIV抗体阴性组病程（中位数为180d）较HIV抗体阳性组（45d）长，前者表现为慢性起病，后者多为急性或亚急性起病；HIV抗体阴性组11例中合并其他基础疾病5例，误诊7例；HIV抗体阳性组未见。（2）HIV抗体阳性组持续高热、呼吸困难出现早，以皮肤软疣样损伤为突出表现；HIV抗体阴性组间歇性反复发热，皮下结节或脓肿明显，而浅表淋巴结肿大（10／11）、骨痛（5／11）、胸痛（7／11）者较HIV抗体阳性组更突出（10／22、2／22、0／22）。（3）HIV抗体阴性组白细胞总数增高多见（9例），而HIV抗体阳性组正常（15例）或降低（7例），且白细胞总数、中性粒细胞与淋巴细胞计数HIV抗体阴性组（中位数为18．6×10^9／L、14．24×10^9／L、2．08×10^9／L）高于HIV抗体阳性组（中位数为4．71×10^9／L、4．16×10^9／L、0．42×10^9／L）。（4）HIV抗体阴性患者CD4／CD8〉0．5，HIV抗体阳性患者低于0．5；（5）HIV抗体阳性组马尔尼菲青霉菌血培养18例均阳性，骨髓培养20例中14例阳性，HIV抗体阴性组分别为7／10例和2／8例。（6）两组胸部影像检查表现为广泛多样的实质性或间质性病变，HIV抗体阴性组常出现高密度实变影及胸膜炎表现，溶骨现象仅见于HIV抗体阴性组（4例）。（7）HIV抗体阴性组临床症状好转7例，恶化及死亡各2例，而HIV抗体阳性组分别为8例、12例及2例。结论两组均以发热、多器官功能损害及预后差为共同特征，但两组在基础疾病、发病症状、病程经过及血白细胞计数等方面有明显区别，提示免疫状况影响两组患者的临床表现及疗效。
Objective To study the differences in the clinical and laboratory characteristics of disseminated penicilliosis marneffei （PSM） in patients with and without human immunodeficiency virus （HIV） infection. Methods The clinical data of 33 patients with PSM in our hospital from 2002 to 2007 were retrospectively analyzed. The patients were divided into 2 groups, an HIV infection group（ n = 22 ） and a non-HIV infection group （ n = 11 ）. The data of the 2 groups were compared. Results The common features in the 2 groups included that, the majority of the patients were manual laborers with a low educational level, and the most common clinical characteristics were fever, multiple organ involvement especially the lung, skin, digestive system, and generalized lymphadenopathy. Different characteristics between the 2 groups included, （ 1 ） In the non-HIV infection group, the duration of the disease was longer （ median ：45 vs 180 d, P 〈 0. 01 ） , with more underlying diseases （ 5/11 ） and higher misdiagnosis rate （ 7/ 11） as compared to those of the HIV infection group; （2） High, persistent fever, acute dyspnea and molluscum of the skin were more common in the HIV infection group, but intermittent fever, subcutaneous nodules and abscess were the features of the non-HIV infection group. Generalized lymphadenopathy （ 10/11 ） , bone ache（5/11 ） and chest pain（7/11 ） were also more common in the non-HIV infection group（ 10/ 22,2/22,0/22, respectively in the HIV infection group, P 〈0. 05; （3）The total white cell counts were mostly increased in the non-HIV infection group （ 9/11 ）, but were mostly in the normal range （ 15/22 ） or decreased（7/22） in the HIV infection group（ P = 0. 000）. The total white cell count, the neutrophil and the lymphocyte counts in the non-HIV infection group were significantly higher than those in the HIV infection group（median： 18.6 ×10^9/L vs 4. 71×10^9/L;14. 24×10^9/L vs 4. 16 ×10^9/L;2.08×10^9/L vs 0. 42 ×10^9/L, P 〈0. 01 ,respectively; （4） The blood CD4/CDs ratio was normal or higher than 0. 5 in the non-HIV infection group, but was , less than 0. 5 in the HIV infection group（P =0. 000） ; （5）The positive rate of blood culture（ 18/18 ） or bone marrow culture （14/20） was significantly higher in the HIV infection group than those in the non-HIV infection group（7/10,2/8 ,P 〈 0. 05, respectively） ; （6）Diffuse parenehymal and interstitial changes were the main manifestations of chest radiology in the 2 groups. High-density consolidation and pleuritis were common in the non-HIV infection group, and osteolysis occurred only in the non-HIV infection group（ n = 4, P 〈 0. 05 ） ; （7） The prognosis was better in the non-HIV infection group （P 〈 0. 05 ）. Conclusion Fever, muhiple organ dysfunction and poor prognosis are common clinical characteristics of PSM in the 2 groups, but there are significantly different characteristics between the 2 groups in underlying diseases, clinical presentations, disease progress and some laboratory studies.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2008年第10期740-746,共7页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
青霉属
人免疫缺陷病毒
感染
Penicillium
Human immunodefieiency virus
Infection
