Wilkes M S, Fortin A H, Felix J C, Godwin T A, Thompson W G
Department of Medicine, New York University School of Medicine, New York.
Lancet. 1988 Jul 9;2(8602):85-8. doi: 10.1016/s0140-6736(88)90014-1.
Necropsy findings in 101 adult patients with the acquired immunodeficiency syndrome (AIDS) from two metropolitan hospitals were compared retrospectively with the antemortem clinical diagnoses. 94% of the patients were male and 68% were homosexual or bisexual. 75 (74%) patients had AIDS-related diseases at necropsy that were not suspected clinically. The commonest of the unsuspected AIDS-related diseases were cytomegalovirus infection (49% of all cases), systemic fungal infection (20%), systemic Kaposi's sarcoma (14%), Mycobacterium avium intracellulare infection (11%), and systemic herpes infection (9%). Cryptococcal infection and cytomegalovirus retinitis were always diagnosed antemortem; and Pneumocystis carinii pneumonia went undiagnosed in only 5 of 58 (9%) patients who had proven infection either clinically or at necropsy. 8 patients who died with fungal pneumonia had undergone bronchoscopy; however, in only 1 patient was it diagnosed antemortem. Tuberculosis was undiagnosed in 4 patients. 4 cases of central nervous system lymphoma diagnosed only at necropsy had been treated empirically for toxoplasmosis. Bacterial pneumonias contributed considerably to mortality in 30% of the patients.
对来自两家大城市医院的101例成年获得性免疫缺陷综合征（AIDS）患者的尸检结果与生前临床诊断进行了回顾性比较。94%的患者为男性，68%为同性恋或双性恋。75例（74%）患者尸检时发现有临床未怀疑的与艾滋病相关的疾病。最常见的未被怀疑的与艾滋病相关的疾病是巨细胞病毒感染（占所有病例的49%）、系统性真菌感染（20%）、系统性卡波西肉瘤（14%）、鸟分枝杆菌胞内感染（11%）和系统性疱疹感染（9%）。隐球菌感染和巨细胞病毒性视网膜炎总是在生前被诊断出来；在临床或尸检已证实感染的58例患者中，仅5例（9%）卡氏肺孢子虫肺炎生前未被诊断出来。8例死于真菌性肺炎的患者接受了支气管镜检查；然而，仅1例在生前被诊断出来。4例患者的结核病生前未被诊断出来。4例仅在尸检时诊断出的中枢神经系统淋巴瘤曾按弓形虫病进行经验性治疗。细菌性肺炎导致30%的患者死亡。
