Klein R S, Smith D, Sobel J, Flanigan T, Margolick J B
Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467, USA.
Int J Tuberc Lung Dis. 2000 Jul;4(7):688-92.
We prospectively studied 1310 women with or at risk for HIV-1 infection to assess subsequent tuberculin reactions in those with > or = 10 mm induration. Forty-seven HIV-positive and 57 negative women had tuberculin reactions > or = 10 mm induration; reversions to reactions < 10 mm occurred in 44% and 46% of those retested, respectively (P = NS). Among seropositives, reversions were associated with lower CD4+ lymphocyte count (P = 0.02). Of a total of 45 subsequent tuberculin tests in seropositive women, only two (4%) resulted in 5-9 mm induration, both at CD4+ counts < 500/mm3. Three (30%) of an additional 10 seropositive women with maximal reactions of 5-9 mm induration reported prior tuberculosis exposure, a significantly lower proportion than the 36/47 (77%) with reactions > or = 10 mm induration (P < 0.01), but not different than women with maximal reaction sizes < 5 mm (219/814, 27%). This study suggests that reversions of > or = 10 mm tuberculin reactions to 5-9 mm are rare. In HIV-positive persons, especially those with CD4+ lymphocyte counts > or = 500/mm3, reaction sizes of 5-9 mm often may not indicate Mycobacterium tuberculosis infection.
我们对1310名感染HIV-1或有感染风险的女性进行了前瞻性研究，以评估硬结≥10毫米者随后的结核菌素反应。47名HIV阳性和57名阴性女性的结核菌素反应硬结≥10毫米；再次检测时，分别有44%和46%的人反应硬结恢复至<10毫米（P=无显著性差异）。在血清阳性者中，反应硬结恢复与较低的CD4+淋巴细胞计数相关（P=0.02）。在血清阳性女性总共45次后续结核菌素检测中，只有两次（4%）硬结为5-9毫米，且CD4+计数均<500/mm3。另外10名血清阳性女性中，硬结最大反应为5-9毫米的有3人（30%）报告有既往结核暴露史，这一比例显著低于硬结≥10毫米的36/47（77%）（P<0.01），但与最大反应大小<5毫米的女性（219/814，27%）无差异。本研究表明，结核菌素反应硬结≥10毫米恢复至5-9毫米的情况很少见。在HIV阳性者中，尤其是CD4+淋巴细胞计数≥500/mm3者，5-9毫米的反应大小往往可能并不表明存在结核分枝杆菌感染。
