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Characteristics of HIV Negative Adult Patients with Mycobacterium Tuberculosis Blood Stream Infection
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摘要:
目的 总结人免疫缺陷病毒(human immunodeficiency virus, HIV)阴性结核分枝杆菌(Mycobacterium tuberculosis, MTB)血流感染(blood stream infection, BSI)患者的临床及实验室特征。 方法 检索并纳入2010年1月至2016年1月北京协和医院HIV阴性, 同时外周血分枝杆菌培养阳性并最终确诊为MTB BSI或外周血培养阴性但病原学确诊的肺结核患者。回顾性分析患者的临床和实验室特征。 结果 6999例送检外周血分枝杆菌培养患者中, 最终筛选纳入28例MTB BSI患者(研究组)和32例外周血培养阴性但病原学确诊的肺结核患者(对照组)。研究组女性患者比例(57%比25%, P=0.011)、体温峰值[(39.70±0.78)℃比(38.70±0.98)℃, P < 0.001)]、累及1个以上器官患者比例(71%比3%, P < 0.001)、合并严重并发症患者比例(32%比3%, P=0.008)和超敏C反应蛋白水平[94.74(61.63~144.21)mg/L比59.97(28.88~104.50)mg/L, P=0.016]均显著高于对照组, 而外周血淋巴细胞计数显著低于对照组[0.44(0.27~0.77)×109/L比1.03(0.52~1.42)×109/L, P=0.001]。 结论 HIV阴性患者也可发生MTB BSI, 尤其高热的女性患者, 病变累及多个器官, 合并严重并发症, 外周血淋巴细胞计数减低而超敏C反应蛋白升高时, 需考虑合并MTB BSI的可能。 Abstract:Objective To summarize the clinical and laboratory characteristics of HIV-negative adult patients with Mycobacterium tuberculosis(MTB) blood stream infection (BSI). Methods We searched databases of the Clinical Laboratory and enrolled HIV-negative patients with blood culture positive for MTB, or the microbiologically confirmed pulmonary TB patients with blood culture negative for MTB from January 2010 to January 2016 in Peking Union Medical College Hospital, and analyzed the clinical and laboratory characteristics of these patients retrospectively. Results A total of 6999 patients with blood culture for Mycobacterium were screened, and 28 patients with MTB BSI (case group) and 32 patients with negative MTB blood culture but microbiologically confirmed pulmonary TB (control group) were enrolled in the present study. The proportion of female (57% vs. 25%, P=0.011), the peak temperature[(39.70±0.78)℃ vs. (38.70±0.98)℃, P < 0.001], the proportion of patients with more than one organ involved (71% vs. 3%, P < 0.001), the proportion of patients with severe complications (32% vs. 3%, P=0.008) and the hypersensitive C reactive protein(hsCRP) level[94.74 (61.63-144.21)mg/L vs. 59.97 (28.88-104.50)mg/L, P=0.016] in the case group were significantly higher than those in the control group. The lymphocyte count in the case group was significant lower than that in the control group[0.44(0.27-0.77)×109/L vs. 1.03(0.52-1.42)×109/L, P=0.001]. Conclusions HIV negative patients can also have MTB BSI. MTB BSI should be considered when female patients with higher temperature, multiple organs involvement, severe complications, lower lymphocytes and higher hsCRP level. -
Key words:
- Mycobacterium tuberculosis /
- blood stream infection /
- HIV negative
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表 1 HIV阴性结核分枝杆菌血流感染与病原学确诊的结核分枝杆菌培养阴性肺结核患者的临床特点
临床资料 研究组(n=28) 对照组(n=32) P值 性别[女, n(%)] 16(57) 8(25) 0.011 年龄(x±s，岁) 50±19 53±19 0.573 伴基础疾病*[n(%)] 15(54) 16(50) 0.880 风湿性疾病 8 6 糖尿病 5** 4 恶性肿瘤 2† † 5† † 慢性肾病 2‡ ‡ 1 血液病 1 1 肝硬化 1 0 结核病史[n(%)] 3(11) 0(0) 0.192 吸烟史[n(%)] 6(21) 14(44) 0.067 发热[n(%)] 28(100) 27(84) 0.086 体温峰值(x±s，℃) 39.70±0.78 38.70±0.98 ＜0.001 盗汗[n(%)] 7(25) 4(13) 0.212 体重减轻[n(%)] 17(61) 13(41) 0.121 病原/病理确诊的其他部位结核病[n(%)] 20(71) 1(3) ＜0.001 并发症[n(%)] 9(32) 1(3) 0.008 *基础疾病通过国际疾病分类诊断获得；* *2例患者同时患有风湿免疫病; † †1例患者同时患有风湿免疫病; ‡ ‡1例患者同时患有2型糖尿病 
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表 2 HIV阴性结核分枝杆菌血流感染与病原学确诊的结核分枝杆菌培养阴性肺结核患者的实验室检查结果
实验室检查项目 研究组(n=28) 对照组(n=32) P值 白细胞计数[M(Q), ×109/L] 6.41(2.76~11.91) 6.53(5.04~10.24) 0.510 淋巴细胞计数[M(Q), ×109/L] 0.44(0.27~0.77) 1.03(0.52~1.42) 0.001 血沉[M(Q)，mm/h] 72(34~84) 56(32~92) 0.632 超敏C反应蛋白[M(Q), mg/L] 94.74(61.63~144.21) 59.97(28.88~104.50) 0.016 T细胞亚群* NK细胞计数[M(Q), ml-1] 59(28~92) 74(30~141) 0.202 CD4+细胞计数[M(Q), ml-1] 173(78~225) 202(141~432) 0.118 CD8+细胞计数[M(Q), ml-1] 217(78~317) 183(108~401) 0.467 注：检查结果选择与血培养采集时间最近的一次, 白细胞计数正常范围：(4~10)×109/L，血沉正常范围：＜20 mm/h，超敏C反应蛋白正常范围：＜3 mg/L；*研究组15例患者、对照组14例患者进行T细胞亚群检测
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表 3 HIV阴性结核分枝杆菌血流感染与病原学确诊的结核分枝杆菌培养阴性肺结核患者的T-SPOT.TB结果
分组 例数 T-SPOT.TB阳性[n(%)] SFCs[M(Q), 106PBMC－1] P值 研究组 25 294(189~774) ALC＜500/ml 11 8(72.7) 0.623 ALC≥500/ml 14 12(85.7) 对照组 25 216(56~462) ALC＜500/ml 5 4(80.0) 0.367 ALC≥500/ml 20 19(95.0) T-SPOT.TB：结核感染T细胞斑点试验；SFCs：斑点形成细胞；ALC：绝对淋巴细胞计数
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