Diaz P T, Clanton T L, Pacht E R
Ohio State University, Columbus.
Ann Intern Med. 1992 Jan 15;116(2):124-8. doi: 10.7326/0003-4819-116-2-124.
To describe a possible association between prolonged infection with human immunodeficiency virus (HIV) and a pathophysiologic process suggestive of pulmonary emphysema.
Case series.
The Ohio State University Hospital, Columbus, Ohio.
We describe four HIV-seropositive individuals ranging in age from 32 to 55 years who presented with dyspnea. Radiographic examination of the chest showed no infiltrates. All patients were presumed to have had prolonged HIV infection (mean CD4 count, 99.8 +/- 43 cells/mm3), but none had a previous history of pneumonia or opportunistic infections. Comprehensive examination of bronchoalveolar lavage fluid showed no pathogens or other complications of HIV infection. All patients had markedly abnormal pulmonary function tests that were suggestive of emphysema with air-trapping, hyperinflation, and a markedly decreased diffusing capacity. However, only minimal evidence of airflow obstruction was noted. Three patients subsequently had high-resolution computed tomographic scans of the chest that revealed emphysema-like bullous changes. Known causes of emphysema were not present in these patients.
Our findings support an association between prolonged HIV infection and an emphysema-like process. This syndrome may occur in the absence of previous pulmonary infections or apparent pulmonary complications and is characterized by unusual pulmonary function test abnormalities.
描述人类免疫缺陷病毒（HIV）长期感染与提示肺气肿的病理生理过程之间可能存在的关联。
病例系列研究。
俄亥俄州哥伦布市的俄亥俄州立大学医院。
我们描述了4例年龄在32至55岁之间的HIV血清学阳性个体，他们均出现呼吸困难症状。胸部X线检查未发现浸润影。所有患者均被推测有长期HIV感染（平均CD4细胞计数为99.8±43个/mm³），但均无肺炎或机会性感染病史。支气管肺泡灌洗液的综合检查未发现病原体或HIV感染的其他并发症。所有患者的肺功能测试均明显异常，提示存在肺气肿伴气体潴留、肺过度充气和弥散能力显著下降。然而，仅发现极轻微的气流阻塞证据。随后，3例患者进行了胸部高分辨率计算机断层扫描，显示出类似肺气肿的肺大泡改变。这些患者不存在已知的肺气肿病因。
我们的研究结果支持长期HIV感染与类似肺气肿的过程之间存在关联。这种综合征可能在无既往肺部感染或明显肺部并发症的情况下发生，其特征为肺功能测试出现异常。
