在联合抗逆转录病毒疗法时代，台湾地区人类免疫缺陷病毒-1 感染患者肺部并发症的病因：一项前瞻性观察研究。

Etiology of pulmonary complications of human immunodeficiency virus-1-infected patients in Taiwan in the era of combination antiretroviral therapy: a prospective observational study.

机构信息

Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Research and Diagnostic Center, Centers of Disease Control, Department of Health, and Department of Tropical Medicine, National Yang-Ming University, Taipei, Taiwan.

出版信息

J Microbiol Immunol Infect. 2013 Dec;46(6):433-40. doi: 10.1016/j.jmii.2012.08.003. Epub 2012 Sep 29.

DOI:10.1016/j.jmii.2012.08.003

PMID:23026388

Abstract

OBJECTIVES

We aimed to investigate the etiology of pulmonary complications of human immunodeficiency virus-(HIV)-1-infected patients in Taiwan in the era of combination antiretroviral therapy (cART).

METHODS

From July 2009 to March 2012, a prospective observational study was conducted to identify the etiology of pulmonary complications in HIV-1-infected patients who sought HIV care at a university hospital in Taiwan. A stepwise diagnostic approach was adopted, which included radiography, serology, microbiology, bronchoscopy or video-assisted thoracoscopic surgery, and polymerase chain reaction assays for cytomegalovirus and Pneumocystis jirovecii.

RESULTS

During the study period, a total of 203 episodes of pulmonary complications that occurred in 190 patients with a mean CD4 count of 123 × 10(6) cells/L were analyzed. Thirty-eight episodes (18.7%) occurred in patients with a CD4 count >200 × 10(6) cells/L, 71 (35.0%) between 50 and 200 × 10(6) cells/L, and 94 (46.3%) <50 × 10(6) cells/L. Pneumocystis pneumonia accounted for more than half of the complications in patients with a CD4 count <200 × 10(6) cells/L. In patients with a CD4 count >200 × 10(6) cells/L, the etiology of pulmonary complications was diverse, with bacterial infections (47.4%) being the most common, followed by tuberculosis (15.8%) and lung edema (13.2%). Pneumocystosis and cytomegalovirus pneumonitis were seen mostly or exclusively in patients with a CD4 count <200 × 10(6) cells/L and were the leading causes of interstitial pneumonitis. On the other hand, empyema, legionellosis, and lung edema were more commonly seen in patients with a CD4 count >200 × 10(6) cells/L.

CONCLUSIONS

The etiology of pulmonary complications in HIV-1-infected patients was diverse and varied with the categories of CD4 counts. Pneumocystosis remained the leading cause of pulmonary complications in patients with lower CD4 counts in Taiwan in the cART era.

摘要

目的

我们旨在研究在联合抗逆转录病毒治疗（cART）时代，台湾地区人类免疫缺陷病毒（HIV）-1 感染患者肺部并发症的病因。

方法

2009 年 7 月至 2012 年 3 月，我们对在台湾一所大学医院寻求 HIV 护理的 HIV-1 感染患者进行了一项前瞻性观察性研究，以确定肺部并发症的病因。采用逐步诊断方法，包括影像学、血清学、微生物学、支气管镜或电视辅助胸腔镜检查，以及巨细胞病毒和卡氏肺孢子虫的聚合酶链反应检测。

结果

在研究期间，共分析了 190 例患者 203 次肺部并发症发作，这些患者的平均 CD4 计数为 123×10^6 个细胞/L。38 次（18.7%）发作发生在 CD4 计数＞200×10^6 个细胞/L 的患者中，71 次（35.0%）发作发生在 50-200×10^6 个细胞/L 的患者中，94 次（46.3%）发作发生在 CD4 计数＜50×10^6 个细胞/L 的患者中。在 CD4 计数＜200×10^6 个细胞/L 的患者中，卡氏肺孢子虫肺炎占肺部并发症的一半以上。在 CD4 计数＞200×10^6 个细胞/L 的患者中，肺部并发症的病因多种多样，以细菌感染（47.4%）最为常见，其次是结核病（15.8%）和肺水肿（13.2%）。卡氏肺孢子虫病和巨细胞病毒肺炎主要见于 CD4 计数＜200×10^6 个细胞/L 的患者，是间质性肺炎的主要原因。另一方面，脓胸、军团菌病和肺水肿更常见于 CD4 计数＞200×10^6 个细胞/L 的患者。