Lee M P, Chan J W, Ng K K, Li P C
Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Respirology. 2000 Dec;5(4):423-6.
The purpose of the present study was to evaluate the impact of HIV infection on the clinical presentation of tuberculosis.
We retrospectively studied the impact of HIV infection on the clinical presentation of tuberculosis. A total of 60 consecutive patients co-infected with HIV and tuberculosis were identified.
Majority were male (88.3%) and the most common transmission category was heterosexual contact (80%). Most were in the advanced stage of HIV infection; 93% had CD4 cell count less than 200/mm3. Concerning the site of tuberculosis involvement, 37% had pulmonary involvement alone, 13% had extrapulmonary disease involving one single site, 50% had both pulmonary and extrapulmonary involvement. Fifteen (25%) patients also met the criteria of disseminated tuberculosis, who had a significantly lower mean CD4 cell count than those with pulmonary involvement alone (mean 40 vs 102; P = 0.048). Chest radiographs comprised a wide spectrum of manifestations. A considerable proportion had primary pulmonary tuberculosis pattern (38%) and normal radiographs (8.5%).
Our patients generally had advanced HIV infection; 93% of those had CD4 lymphocyte count < 200/mm3. Extrapulmonary involvement and disseminated disease were common. Radiographic manifestations of pulmonary tuberculosis were often 'atypical' due to the greater proportion of primary tuberculosis among our patients.
本研究旨在评估HIV感染对结核病临床表现的影响。
我们回顾性研究了HIV感染对结核病临床表现的影响。共确定了60例连续的HIV和结核病合并感染患者。
大多数为男性（88.3%），最常见的传播途径是异性接触（80%）。大多数处于HIV感染晚期；93%的患者CD4细胞计数低于200/mm³。关于结核病累及部位，37%仅累及肺部，13%有肺外单一部位病变，50%同时有肺部和肺外累及。15例（25%）患者还符合播散性结核病标准，其平均CD4细胞计数显著低于仅累及肺部的患者（平均40对102；P = 0.048）。胸部X线表现多种多样。相当一部分有原发性肺结核表现（38%），X线正常者占8.5%。
我们的患者普遍处于HIV感染晚期；其中93%的患者CD4淋巴细胞计数<200/mm³。肺外累及和播散性疾病很常见。由于我们的患者中原发性肺结核比例较高，肺结核的影像学表现往往“不典型”。
