Mofenson L M, Rodriguez E M, Hershow R, Fox H E, Landesman S, Tuomala R, Diaz C, Daniels E, Brambilla D
National Institutes of Health, Rockville, Md, USA.
Arch Intern Med. 1995 May 22;155(10):1066-72.
Prevalence of Mycobacterium tuberculosis (TB) infection and anergy were evaluated in a cohort of pregnant and nonpregnant women infected with the human immunodeficiency virus who were enrolled in a prospective natural history study (the Women and Infants Transmission Study) conducted in New York, NY; Boston and Worcester, Mass; Chicago, Ill; and San Juan, Puerto Rico.
One hundred eighty-three women (65 pregnant, 118 nonpregnant) were evaluated for TB. The TB history and risk factors were assessed by interview and medical record review. Intradermal skin testing with tuberculin, mumps, and tetanus antigens and CD4+ lymphocyte count were performed.
Overall prevalence of TB infection or disease by documented medical history and/or a tuberculin skin test induration of 5 mm or more was 14% (26 of 183). History of TB infection or disease was documented in 11% of the women who were interviewed. Tuberculin and anergy skin test results were evaluable for 124 women; 6% (seven of 124) had tuberculin skin test induration of 5 mm or more, including 11% (five of 46) of the pregnant women who were tested. Induration between 2 and 5 mm was observed in four more women, three of whom were pregnant. Anergy was observed in 42% (52 of 124); prevalence of anergy was higher in nonpregnant women (38 [49%] of 78) than in pregnant women (14 [30%] of 46). While anergy was more common in women with a CD4+ cell count of 0.5 x 10(9)/L or less, 27% of those with a CD4+ cell count of more than 0.5 x 10(9)/L were also anergic.
These data support current Public Health Service recommendations for tuberculin skin testing in persons infected with the human immunodeficiency virus, and emphasize that evaluation should include pregnant as well as nonpregnant women. The prevalence of anergy does not appear increased in pregnancy in women infected with the human immunodeficiency virus. Health care providers should include tuberculin and anergy skin testing as part of the standard prenatal care for women infected with the human immunodeficiency virus.
在纽约州纽约市、马萨诸塞州波士顿和伍斯特、伊利诺伊州芝加哥以及波多黎各圣胡安开展的一项前瞻性自然史研究（母婴传播研究）中，对一组感染人类免疫缺陷病毒的孕妇和非孕妇进行了结核分枝杆菌（TB）感染及无反应性评估。
对183名女性（65名孕妇，118名非孕妇）进行了结核病评估。通过访谈和病历审查评估结核病病史及危险因素。进行了结核菌素、腮腺炎和破伤风抗原的皮内皮肤试验以及CD4 +淋巴细胞计数检测。
根据有记录的病史和/或结核菌素皮肤试验硬结直径达5毫米或更大，结核病感染或疾病的总体患病率为14%（183人中的26人）。接受访谈的女性中有11%有结核病感染或疾病史。124名女性的结核菌素和无反应性皮肤试验结果可评估；6%（124人中的7人）结核菌素皮肤试验硬结直径达5毫米或更大，其中接受检测的孕妇中有11%（46人中的5人）。另有4名女性硬结直径在2至5毫米之间，其中3名是孕妇。42%（124人中的52人）出现无反应性；非孕妇中的无反应性患病率（78人中的38人[49%]）高于孕妇（46人中的14人[30%]）。虽然无反应性在CD4 +细胞计数为0.5×10⁹/L或更低的女性中更常见，但CD4 +细胞计数超过0.5×10⁹/L的女性中也有27%出现无反应性。
这些数据支持美国公共卫生服务部目前关于对感染人类免疫缺陷病毒者进行结核菌素皮肤试验的建议，并强调评估应包括孕妇和非孕妇。感染人类免疫缺陷病毒的女性在孕期无反应性患病率似乎并未增加。医疗保健提供者应将结核菌素和无反应性皮肤试验纳入感染人类免疫缺陷病毒女性标准产前检查的一部分。
