Gounder Lilishia, Moodley Pravikrishnen, Drain Paul K, Hickey Andrew J, Moosa Mahomed-Yunus S
Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Durban, Mayville, 4058, South Africa.
BMC Infect Dis. 2017 Feb 1;17(1):115. doi: 10.1186/s12879-017-2222-2.
Although Mycobacterium tuberculosis (TB) infection may cause extrapulmonary disease in HIV-infected adults, HIV-associated hepatic TB has been poorly characterized. Our objective was to describe hepatic TB in HIV-infected adults.
Retrospective study of patients diagnosed with hepatic TB from 2005-2012 at Infectious Diseases Clinic, King Edward VIII Hospital, Durban, South Africa.
Among twenty cases of histology-confirmed HIV-associated hepatic TB, median CD4 count was 47 cells/μl (inter-quartile range 27-107 cells/μl) and 75% (15/20) of patients had pre-existing pulmonary TB. The most frequent clinical finding was hepatomegaly (85%). Liver enzyme abnormalities included elevated alkaline phosphatase (median 456 u/L, inter-quartile range 322-1,043 u/L) and gamma-glutamyltransferase (median 422 u/L, inter-quartile range 235-736 u/L). Acid-fast bacilli were cultured from liver tissue in 30% (6/20) of patients; 25% (5/20) identified as TB. With standard anti-TB therapy, liver enzymes improved within six months in 92% (11/12) of patients. One year after diagnosis, twelve patients resolved clinically, two patients developed drug-resistant TB and six patients died.
In our case series of HIV-infected patients, hepatic TB occurred in patients with severe immunosuppression, who presented with hepatomegaly and abnormal liver enzymes. More than half of patients had resolution of liver function by six months however the 12-month mortality remained high.
虽然结核分枝杆菌感染可能导致HIV感染成人发生肺外疾病，但HIV相关肝结核的特征尚不明确。我们的目的是描述HIV感染成人中的肝结核情况。
对2005年至2012年在南非德班爱德华八世国王医院传染病诊所诊断为肝结核的患者进行回顾性研究。
在20例经组织学确诊的HIV相关肝结核病例中，CD4细胞计数中位数为47个/μl（四分位间距为27 - 107个/μl），75%（15/20）的患者既往有肺结核。最常见的临床发现是肝肿大（85%）。肝功能异常包括碱性磷酸酶升高（中位数456 u/L，四分位间距322 - 1043 u/L）和γ-谷氨酰转移酶升高（中位数422 u/L，四分位间距235 - 736 u/L）。30%（6/20）的患者肝组织培养出抗酸杆菌；其中25%（5/20）被鉴定为结核杆菌。采用标准抗结核治疗后，92%（11/12）的患者肝功能在6个月内有所改善。诊断1年后，12例患者临床症状缓解，2例患者发展为耐药结核病，6例患者死亡。
在我们的HIV感染患者病例系列中，肝结核发生于严重免疫抑制的患者，这些患者表现为肝肿大和肝功能异常。超过一半的患者在6个月时肝功能恢复，但12个月死亡率仍然很高。
