Bakhshayesh-Karam Mehrdad, Tabarsi Payam, Mirsaiedi Seyed Mehdi, Amiri Majid Valiollahpour, Zahirifard Soheila, Mansoori Seyed Davood, Masjedi Mohammad Reza, Velayati Ali Akbar
Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Mycobacteriol. 2016 Dec;5 Suppl 1:S244-S245. doi: 10.1016/j.ijmyco.2016.11.027. Epub 2016 Dec 5.
Observations on Tuberculosis/HIV co-infection in addition to epidemiologic molecular studies have recently provided strong evidence for the state of immune system as the major determinant of the TB imaging spectrum. However, the presence of any correlation between radiographic findings and the degree of immunosuppression in HIV+ patients still remains controversial. The present study aimed to investigate the TB radiographic manifestation in HIV+ patients and its relationship to the CD4 cell count.
Chest radiography of 15 HIV+ patients with a definite diagnosis of pulmonary Tuberculosis in Masih Daneshvari Hospital, between 2013 and 2014, were retrospectively reviewed. Radiographic findings and severity were categorized as typical (upper lobe infiltration/cavity) and atypical (middle/lower lobe opacity, adenopathy, pleural effusion and normal X-ray). Demographics and CD4+ cell count were also recorded. Data analysis was performed using SPSS version 23 (frequency and mean for descriptive quantitative variables and Logistic regression analysis for correlation, p<0.05).
Of a total 15 patients (86.7% men and 13.3% women), 78.6% had CD4+ counts <350 (mean±SD; 229.15±199.45). The most common radiographic findings in descending order of frequency were adenopathy (53.3%), pleural effusion (26.7%) and cavitation (6.7%) with an overall atypical presentation of 93.3%. This study failed to reveal any statistically significant correlation between CD4+ cell count and radiographic manifestation as well as severity.
In CD4+ cell count <500, the dominant radiographic pattern of Tuberculosis is atypical presentation. At this level of immunity, CD4+ T cell dysfunction may play a deterministic role in TB radiographic manifestation.
除了流行病学分子研究外，对结核病/艾滋病病毒合并感染的观察最近为免疫系统状态作为结核影像学谱的主要决定因素提供了有力证据。然而，在艾滋病毒阳性患者中，影像学表现与免疫抑制程度之间是否存在任何相关性仍存在争议。本研究旨在调查艾滋病毒阳性患者的结核影像学表现及其与CD4细胞计数的关系。
回顾性分析了2013年至2014年期间在马西·达内什瓦里医院确诊为肺结核的15例艾滋病毒阳性患者的胸部X线片。影像学表现和严重程度分为典型（上叶浸润/空洞）和非典型（中/下叶模糊、淋巴结肿大、胸腔积液和X线正常）。还记录了人口统计学数据和CD4+细胞计数。使用SPSS 23版进行数据分析（描述性定量变量的频率和均值，相关性分析采用逻辑回归分析，p<0.05）。
在总共15例患者中（男性占86.7%，女性占13.3%），78.6%的患者CD4+细胞计数<350（均值±标准差；229.15±199.45）。按频率降序排列，最常见的影像学表现为淋巴结肿大（53.3%）、胸腔积液（26.7%）和空洞形成（6.7%），总体非典型表现为93.3%。本研究未能揭示CD4+细胞计数与影像学表现及严重程度之间存在任何统计学上的显著相关性。
在CD4+细胞计数<500时，结核病的主要影像学模式为非典型表现。在这种免疫水平下，CD4+T细胞功能障碍可能在结核影像学表现中起决定性作用。
