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目的分析结核相关性免疫重建炎性综合征(TB-associated immune reconstitution inflammatory syndrome,TB-IRIS)的发生率、临床特征、危险因素及预后,以提高对该临床综合征的认识,减少其不良影响。方法回顾性分析HIV/TB双重感染者临床资料,计算TB-IRIS发生率,并对比分析TB-IRIS的发生与年龄、性别、入院时CD_4~+细胞计数、入院时HIV RNA定量及结核病类型等指标是否存在相关性。结果 HIV/TB病例共305例,其中13.1%(40例)发生TB-IRIS;发生TB-IRIS者治疗前CD_4~+细胞计数显著低于未发生TB-IRIS者,发生TB-IRIS者平均年龄低于未发生TB-IRIS者(P<0.05);抗逆转录病毒(ART)治疗6个月内发生TB-IRIS者CD_4~+细胞增长值高于未发生TB-IRIS者,但1年后两组患者CD_4~+细胞计数增长值相近;40例TB-IRIS病例均有发热,体温≥39.0℃者85.0%;TBIRIS治愈率为95.0%,病死率为5.0%。结论 TB-IRIS多发生于ART治疗后1个月之内;治疗前CD_4~+细胞计数≤50个/μL及年龄≤60岁是TB-IRIS发生的危险因素;TB-IRIS预后良好。
Objective To analyze the incidence, clinical characteristics, risk factors and prognosis of TB-associated immune reconstitution inflammatory syndrome (TB-IRIS) in order to improve their understanding of the clinical syndrome and reduce their adverse effects . Methods The clinical data of patients with HIV / TB infection were retrospectively analyzed. The incidence of TB-IRIS was calculated. The incidence of TB-IRIS was compared with age, sex, CD_4 + cell count at admission, HIV RNA quantification and tuberculosis types Is the indicator relevant? Results A total of 305 cases of HIV / TB cases were diagnosed as TB-IRIS in 13.1% (40 cases). The counts of CD 4 + cells in TB-IRIS patients before TB-IRIS treatment were significantly lower than those without TB-IRIS. The average age of TB-IRIS patients (P <0.05). The growth of CD_4 ~ + cells in TB-IRIS patients within 6 months after anti-retroviral therapy (ART) was higher than those without TB-IRIS, but after 1 year The growth of CD_4 ~ + cells in both groups were similar. The incidence of fever in all 40 TB-IRIS patients was 85.0% with body temperature≥39.0 ℃. The cure rate of TBIRIS was 95.0% and the case fatality rate was 5.0%. Conclusion TB-IRIS occurred mostly within 1 month after ART treatment. Before treatment, the count of CD_4 ~ + cells ≤50 / μL and age ≤60 years were the risk factors of TB-IRIS. The prognosis of TB-IRIS was good.