Flegg P J, Laing R B, Lee C, Harris G, Watt B, Leen C L, Brettle R P
Regional Infectious Diseases Unit, City Hospital, Edinburgh, UK.
QJM. 1995 Sep;88(9):617-26.
We retrospectively analysed 46 cases of disseminated infection with Mycobacterium avium complex (MAC) within a cohort of 702 HIV-infected patients in Edinburgh. Clinical features were compared with case-matched controls (AIDS cases without disseminated MAC), and survival and progression times were controlled for confounding variables that influence survival. Disseminated MAC was diagnosed antemortem in 18% of AIDS patients, and was the AIDS-defining diagnosis in 6% of all AIDS cases. Concomitant colonization of respiratory and gastrointestinal tracts was common (61% and 48%, respectively). In 58% of cases, CD4+ counts were < 10 cells/mm3 (median 6 cells/mm3). Weight loss, anaemia, leucopenia, and elevated liver transaminases and alkaline phosphatase were significantly more common among cases than controls. Therapy was given in 74%, and not tolerated in 32%. Following AIDS diagnosis, disseminated MAC incidence was 14% at one year, 25% at 2 years and 36% at 3 years. Median survival after disseminated MAC diagnosis was 6 months, with shorter survival in untreated cases. However, overall survival from AIDS diagnosis was not significantly different between patients who did or did not develop disseminated MAC. Disseminated MAC contributes significantly to AIDS morbidity, and its incidence increases with prolonged AIDS survival. Although survival following diagnosis is short, the development of disseminated MAC in AIDS probably does not affect overall survival. In cohorts with a low incidence, an alternative to prophylaxis might be surveillance and early diagnosis.
我们回顾性分析了爱丁堡702例HIV感染患者队列中46例播散性鸟分枝杆菌复合体（MAC）感染病例。将临床特征与病例匹配对照（无播散性MAC的艾滋病病例）进行比较，并对影响生存的混杂变量进行控制，以分析生存和进展时间。18%的艾滋病患者在生前被诊断为播散性MAC，在所有艾滋病病例中，6%的病例以此作为艾滋病确诊诊断。呼吸道和胃肠道同时定植很常见（分别为61%和48%）。58%的病例中，CD4 + 细胞计数＜10个细胞/mm³（中位数为6个细胞/mm³）。与对照组相比，病例组体重减轻、贫血、白细胞减少以及肝转氨酶和碱性磷酸酶升高更为常见。74%的患者接受了治疗，32%的患者不耐受治疗。艾滋病确诊后，播散性MAC的发病率在1年时为14%，2年时为25%，3年时为36%。播散性MAC诊断后的中位生存期为6个月，未治疗病例的生存期较短。然而，发生或未发生播散性MAC的患者从艾滋病确诊后的总体生存期并无显著差异。播散性MAC对艾滋病发病率有显著影响，其发病率随艾滋病生存期延长而增加。虽然确诊后的生存期较短，但艾滋病患者发生播散性MAC可能并不影响总体生存期。在发病率较低的队列中，除了进行预防外，另一种选择可能是监测和早期诊断。
