Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
HIV Med. 2009 Mar;10(3):191-8. doi: 10.1111/j.1468-1293.2008.00674.x. Epub 2009 Jan 7.
Although many studies have been carried out on pulmonary diseases in HIV-infected patients, studies specifically investigating the aetiologies of cavitary lung lesions are rare.
HIV-infected patients enrolled in a cohort study who presented with cavitary lung lesions by radiography were identified between June 1994 and March 2008. Medical records and radiological and microbiological data for these patients were retrospectively reviewed using a standardized case collection form.
During the 14-year study period, 73 episodes of cavitary lung lesions were diagnosed in 66 of 1790 (3.7%) HIV-infected patients. At the diagnosis of cavitary lung lesions, the median CD4 count was 25 cells/microL (range 1-575 cells/microL). Eighty-one pathogens were considered causative, with fungi being the most common aetiology (42.0%), followed by bacteria (29.6%) and mycobacteria (25.9%). Of the fungal pneumonias, 19 (55.9%) were caused by Penicillium marneffei, 11 (32.4%) by Cryptococcus neoformans, two (5.9%) by Pneumocystis jirovecii, and two (5.9%) by Aspergillus species. During the study period, 11 of 205 patients (5.4%) who were diagnosed as having tuberculosis presented with cavitary lung lesions, compared with 19 of 36 patients (52.8%) with penicilliosis and 11 of 64 patients (17.2%) with cryptococcosis (P<0.0001). The median CD4 count of patients with cavitary lung lesions resulting from tuberculosis (115 cells/microL) was significantly higher than that of patients with cavitary lung lesions resulting from penicilliosis (4 cells/microL) and cryptococcosis (29.5 cells/microL).
Our findings suggest that invasive infections attributable to endemic fungi were the leading cause of cavitary lung lesions among patients in the late stage of HIV infection, and were more common than infections attributable to bacteria and mycobacteria.
尽管已有许多针对 HIV 感染者肺部疾病的研究，但专门研究空洞性肺部病变病因的研究却很少。
本研究对 1994 年 6 月至 2008 年 3 月期间在队列研究中出现影像学表现为空洞性肺部病变的 HIV 感染者进行了回顾性分析。使用标准化病例采集表对这些患者的病历、影像学和微生物学数据进行了回顾性分析。
在 14 年的研究期间，在 1790 例 HIV 感染者中，有 66 例（3.7%）诊断为 73 例空洞性肺部病变。在诊断空洞性肺部病变时，中位 CD4 计数为 25 个/μL（范围 1-575 个/μL）。共考虑了 81 种病原体，其中真菌是最常见的病因（42.0%），其次是细菌（29.6%）和分枝杆菌（25.9%）。在真菌性肺炎中，19 例（55.9%）由马尔尼菲青霉菌引起，11 例（32.4%）由新型隐球菌引起，2 例（5.9%）由卡氏肺孢子菌引起，2 例（5.9%）由曲霉菌引起。在研究期间，诊断为结核病的 205 例患者中有 11 例（5.4%）出现空洞性肺部病变，而感染马尔尼菲青霉菌的 36 例患者中有 19 例（52.8%），感染新型隐球菌的 64 例患者中有 11 例（17.2%）出现空洞性肺部病变（P<0.0001）。结核病导致的空洞性肺部病变患者的中位 CD4 计数（115 个/μL）明显高于由马尔尼菲青霉菌引起的空洞性肺部病变患者（4 个/μL）和新型隐球菌引起的空洞性肺部病变患者（29.5 个/μL）。
我们的研究结果表明，地方性真菌感染所致的侵袭性感染是 HIV 感染者晚期出现空洞性肺部病变的主要原因，且比细菌和分枝杆菌感染更为常见。
