Palmieri F, Girardi E, Pellicelli A M, Rianda A, Bordi E, Rizzi E Busi, Petrosillo N, Ippolito G
2nd Infectious Diseases Unit, National Institute for Infectious Diseases, L. Spallanzani-IRCCS, Rome Italy.
Infection. 2002 Apr;30(2):68-74. doi: 10.1007/s15010-002-2062-9.
HIV-infected patients with pulmonary tuberculosis exhibit atypical radiological presentation and negative sputum smear more frequently than their HIV-negative counterparts.
We performed a retrospective study based on a chart review of 146 HIV-infected patients with pulmonary symptoms and culture-proven pulmonary tuberculosis. We compared clinical characteristics and the outcome in 71 patients (49%) with positive sputum smear (SS+), 62 patients (42%) with negative sputum smear/abnormal chest X-ray (SS-/CXR+) and 13 patients (9%) with negative sputum smear/normal chest X-ray (SS-/CXR-). Patients were enrolled from January 1987 to December 1998, and were followed up until December 1999.
On hospital admission the three groups of patients examined did not differ significantly in demographic characteristics, degree of immunosuppression or Mycobacterium tuberculosis drug-susceptibility pattern. SS-/CXR- patients were significantly Less LikeLy to present with prolonged fever and dyspnea. Median survival was shorter for SS-/CXR- patients (6.4 months vs 20.2 and 18.8 months in the other two groups). In multivariate analysis, SS-/CXR-patients had a significantly increased risk of death (hazard ratio 3.0, 95% confidence interval, 1.4 to 6.4, p = 0.004) compared to SS+ patients. This increase in risk was no longer statistically significant when initiation of antituberculous therapy within 8 weeks from the collection date of the first specimen yielding M. tuberculosis was included in the multivariate model.
Decreased survival was observed in HIV-infected patients with pulmonary tuberculosis and with both negative sputum smear and normaL chest X-ray presentation. This may primarily be a resuLt of delayed tuberculosis diagnosis and initiation of antituberculous therapy. The latter delay may also lead to a faster progression of HIV infection in SS-/CXR patients, in whom diagnostic oversight may be common.
与未感染艾滋病毒的肺结核患者相比，感染艾滋病毒的肺结核患者更常表现出不典型的放射学表现且痰涂片结果为阴性。
我们基于对146例有肺部症状且经培养证实患有肺结核的艾滋病毒感染患者的病历回顾进行了一项回顾性研究。我们比较了71例（49%）痰涂片阳性（SS+）、62例（42%）痰涂片阴性/胸部X线异常（SS-/CXR+）和13例（9%）痰涂片阴性/胸部X线正常（SS-/CXR-）患者的临床特征及转归。患者入组时间为1987年1月至1998年12月，并随访至1999年12月。
入院时，三组接受检查的患者在人口统计学特征、免疫抑制程度或结核分枝杆菌药敏模式方面无显著差异。SS-/CXR-患者出现持续发热和呼吸困难的可能性显著较低。SS-/CXR-患者的中位生存期较短（6.4个月，而其他两组分别为20.2个月和18.8个月）。在多变量分析中，与SS+患者相比，SS-/CXR-患者的死亡风险显著增加（风险比3.0，95%置信区间1.4至6.4，p = 0.004）。当从首个培养出结核分枝杆菌的标本采集日期起8周内开始抗结核治疗纳入多变量模型时，这种风险增加不再具有统计学意义。
在痰涂片阴性且胸部X线表现正常的艾滋病毒感染肺结核患者中观察到生存期缩短。这可能主要是结核诊断延迟和抗结核治疗开始延迟的结果。后一种延迟也可能导致SS-/CXR患者中艾滋病毒感染进展更快，而这些患者中诊断疏忽可能很常见。
