Morris A M, Huang L, Bacchetti P, Turner J, Hopewell P C, Wallace J M, Kvale P A, Rosen M J, Glassroth J, Reichman L B, Stansell J D
San Francisco General Hospital, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, USA.
Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):612-6. doi: 10.1164/ajrccm.162.2.9912058.
Human immunodeficiency virus (HIV)-associated respiratory infections, most notably Pneumocystis carinii pneumonia (PCP), but also bacterial pneumonia (BP), result in reductions in lung function that have been studied mainly during the course of acute infection. Whether HIV-associated pneumonias also cause permanent changes in pulmonary function is unknown. In this study we investigated the long-term effects of PCP and BP on pulmonary function in a cohort of HIV-infected persons. One thousand, one hundred forty-nine HIV-infected persons were followed in a prospective, observational cohort study at six centers in the United States. Study participants had pulmonary function testing performed at regular preset intervals. PCP and BP diagnoses were verified with defined criteria. Longitudinal multivariate analysis was used to model pulmonary function in terms of demographic data and occurrence of PCP or BP. We found that PCP or BP was associated with permanent decreases in FEV(1), FVC, FEV(1)/FVC, and the diffusing capacity of carbon monoxide. Neither infection resulted in statistically significant changes in TLC. We conclude that PCP and BP result in expiratory airflow reductions that persist after the acute infection resolves. The clinical implications of these changes are unknown, but they may contribute to prolonged respiratory complaints in HIV-infected patients who have had pneumonia.
人类免疫缺陷病毒（HIV）相关的呼吸道感染，最显著的是卡氏肺孢子虫肺炎（PCP），但也包括细菌性肺炎（BP），会导致肺功能下降，这主要是在急性感染过程中进行研究的。HIV相关肺炎是否也会导致肺功能的永久性改变尚不清楚。在本研究中，我们调查了PCP和BP对一组HIV感染者肺功能的长期影响。在美国的六个中心对1149名HIV感染者进行了一项前瞻性观察队列研究。研究参与者按照预先设定的固定间隔进行肺功能测试。PCP和BP的诊断通过明确的标准进行核实。采用纵向多变量分析，根据人口统计学数据以及PCP或BP的发生情况对肺功能进行建模。我们发现，PCP或BP与第一秒用力呼气容积（FEV(1)）、用力肺活量（FVC）、FEV(1)/FVC以及一氧化碳弥散量的永久性下降相关。两种感染均未导致肺总量（TLC）出现具有统计学意义的变化。我们得出结论，PCP和BP会导致呼气气流减少，且在急性感染消退后仍持续存在。这些变化的临床意义尚不清楚，但它们可能导致曾患肺炎的HIV感染患者出现长期的呼吸道不适症状。
