肺结核：南非索韦托地区感染艾滋病毒者的不同放射学表现
Pulmonary TB: varying radiological presentations in individuals with HIV in Soweto, South Africa.
作者信息
Kistan Jesne, Laher Fatima, Otwombe Kennedy, Panchia Ravindre, Mawaka Nohemie, Lebina Limakatso, Diacon Andreas, Kana Bavesh, Martinson Neil
机构信息
Perinatal HIV Research Unit and MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB (SoMCHAT), Faculty of Health Sciences, University of the Witwatersrand, South Africa.
Department of Community Health, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
出版信息
Trans R Soc Trop Med Hyg. 2017 Mar 1;111(3):132-136. doi: 10.1093/trstmh/trx028.
BACKGROUND
HIV-uninfected individuals with pulmonary TB (PTB) commonly present with radiological features of upper lobe cavitatory disease. In contrast, individuals with HIV and PTB may present differently. This study compared radiological features of individuals with laboratory-confirmed PTB by HIV status from the largest study in South Africa.
METHODS
We conducted a cross-sectional analysis of adults recruited between 2012 and 2015 with laboratory-confirmed PTB in Soweto, South Africa. Baseline characteristics and chest radiograph (CXR) findings were compared by χ2 test stratified by HIV status.
RESULTS
Of the 474 individuals with PTB, 348 (73.4%) had HIV. Individuals with HIV had a higher proportion of infiltrates (58.9% vs 46.8%, p=0.02) and a lower proportion of cavitations (40.8% vs 68.3%; p<0.0001) compared to HIV-uninfected individuals. Additionally, individuals with HIV had a lower proportion of cavitations sized ≥4 cm (16.7% vs 36.5%, p<0.001) and a lower proportion of disease extent involving half or more of the total lung area radiologically (25.9% vs 45.3%, p<0.0001).
CONCLUSIONS
Individuals with HIV co-infected with PTB have a higher proportion of infiltrates and a lower proportion of cavitations relative to the HIV-uninfected PTB individuals. The absence of classical upper lobe cavitatory disease on CXR does not exclude PTB in individuals with HIV.
背景
未感染艾滋病毒的肺结核（PTB）患者通常表现为上叶空洞性疾病的放射学特征。相比之下，感染艾滋病毒的肺结核患者可能有不同的表现。本研究通过南非规模最大的一项研究，比较了经实验室确诊的肺结核患者根据艾滋病毒感染状况的放射学特征。
方法
我们对2012年至2015年在南非索韦托招募的经实验室确诊为肺结核的成年人进行了横断面分析。通过按艾滋病毒感染状况分层的χ2检验比较基线特征和胸部X线片（CXR）检查结果。
结果
在474例肺结核患者中，348例（73.4%）感染了艾滋病毒。与未感染艾滋病毒的患者相比，感染艾滋病毒的患者浸润比例更高（58.9%对46.8%，p=0.02），空洞形成比例更低（40.8%对68.3%；p<0.0001）。此外，感染艾滋病毒的患者空洞大小≥4 cm的比例更低（16.7%对36.5%，p<0.001），放射学上疾病累及肺总面积一半或更多的比例更低（25.9%对45.3%，p<0.0001）。
结论
与未感染艾滋病毒的肺结核患者相比，合并感染艾滋病毒的肺结核患者浸润比例更高，空洞形成比例更低。胸部X线片上无典型的上叶空洞性疾病并不能排除艾滋病毒感染者患肺结核。
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