Johnson J E, Anders G T, Hawkes C E, LaHatte L J, Blanton H M
Pulmonary Disease Service and Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, Tex.
Chest. 1990 May;97(5):1066-71. doi: 10.1378/chest.97.5.1066.
To evaluate bronchoalveolar lavage (BAL) findings in patients infected with human immunodeficiency virus (HIV), 39 patients seropositive for the virus but with no history of opportunistic infection were studied. Opportunistic organisms such as Pneumocystis carinii were not found in any of the 35 BAL fluids sent for special stains and cultures. Three of 16 (18 percent) BAL fluids sent for HIV culture were positive compared with a 60.9 percent blood HIV culture positivity in the same group. To evaluate cellular recovery, the patients were divided into Walter Reed (WR) groups 1 and 2 (blood CD4 greater than or equal to 400/cu mm) and WR3 to WR5 (blood CD4 less than 400/cu mm). Compared with ten nonsmoking healthy controls, the WR1 and WR2 group had a greater overall cellular recovery but this was not statistically significant when the smokers were excluded. There was no difference in macrophage or lymphocyte percentages in either patient group compared with controls. T-cell subset analysis of a small group of WR1 to WR5 patient BAL fluids revealed no difference in CD4 numbers or the CD4/CD8 rate between WR1 and WR2 and WR3 to WR5 patients. We conclude that opportunistic pulmonary infection is unlikely in HIV-seropositive patients with normal chest roentgenograms despite symptoms of dyspnea on exertion. Also, HIV can be isolated from BAL fluid from these patients although not as often as from blood. Finally, there appears to be no distinct progression in BAL cellular findings before the onset of acquired immunodeficiency syndrome.
为评估感染人类免疫缺陷病毒（HIV）患者的支气管肺泡灌洗（BAL）结果，对39例病毒血清学阳性但无机会性感染病史的患者进行了研究。在送去做特殊染色和培养的35份BAL液中，均未发现卡氏肺孢子虫等机会性生物体。送去做HIV培养的16份BAL液中有3份（18%）呈阳性，而同一组患者血液HIV培养阳性率为60.9%。为评估细胞回收率，将患者分为沃尔特里德（WR）1组和2组（血液CD4大于或等于400/立方毫米）以及WR3至WR5组（血液CD4小于400/立方毫米）。与10名不吸烟的健康对照者相比，WR1和WR2组的总体细胞回收率更高，但排除吸烟者后，这一差异无统计学意义。与对照组相比，两组患者的巨噬细胞或淋巴细胞百分比均无差异。对一小部分WR1至WR5患者的BAL液进行T细胞亚群分析发现，WR1和WR2组与WR3至WR5组患者之间的CD4数量或CD4/CD8比率无差异。我们得出结论，胸部X线片正常的HIV血清学阳性患者，尽管有劳力性呼吸困难症状，但发生机会性肺部感染的可能性不大。此外，这些患者的BAL液中可分离出HIV，尽管频率不如血液高。最后，在获得性免疫缺陷综合征发病前，BAL细胞检查结果似乎没有明显进展。
