Jones B E, Young S M, Antoniskis D, Davidson P T, Kramer F, Barnes P F
Department of Medicine, University of Southern California School of Medicine, Los Angeles.
Am Rev Respir Dis. 1993 Nov;148(5):1292-7. doi: 10.1164/ajrccm/148.5.1292.
To evaluate the relationship between the clinical presentation of tuberculosis and the CD4 cell count in patients with human immunodeficiency virus (HIV) infection, we evaluated clinical and laboratory features of 97 HIV-infected patients with tuberculosis in whom CD4 cell counts were available. Extrapulmonary tuberculosis was found in 30 (70%) of 43 patients with < or = 100 CD4 cells/microL, 10 (50%) of 20 patients with 101 to 200 CD4 cells/microL, seven (44%) of 16 patients with 201 to 300 CD4 cells/microL, and five (28%) of 18 patients with > 300 CD4 cells/microL (p = 0.02). Mycobacteremia was found in 18 (49%) of 37 patients with < or = 100 CD4 cells/microL, three (20%) of 15 patients with 101 to 200 CD4 cells/microL, one (7%) of 15 patients with 201 to 300 CD4 cells/microL, and none of eight patients with > 300 CD4 cells/microL (p = 0.002). Acid-fast smears were more often positive in patients with low CD4 cell counts. Positive tuberculin skin tests were more common in patients with high CD4 counts. On chest roentgenograms, mediastinal adenopathy was noted in 20 (34%) of 58 patients with < or = 200 CD4 cells/microL and four (14%) of 29 patients with > 200 CD4 cells/microL (p = 0.04). Pleural effusions were noted in six (10%) of 58 patients with < or = 200 CD4 cells/microL and eight (28%) of 29 patients with > 200 CD4 cells/microL (p = 0.04). The CD8 cell counts did not correlate with the manifestations of tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估人类免疫缺陷病毒（HIV）感染患者中结核病的临床表现与CD4细胞计数之间的关系，我们对97例有CD4细胞计数数据的HIV感染合并结核病患者的临床和实验室特征进行了评估。在CD4细胞计数≤100个/微升的43例患者中，30例（70%）有肺外结核；CD4细胞计数为101至200个/微升的20例患者中，10例（50%）有肺外结核；CD4细胞计数为201至300个/微升的16例患者中，7例（44%）有肺外结核；CD4细胞计数＞300个/微升的18例患者中，5例（28%）有肺外结核（p = 0.02）。在CD4细胞计数≤100个/微升的37例患者中，18例（49%）有菌血症；CD4细胞计数为101至200个/微升的15例患者中，3例（20%）有菌血症；CD4细胞计数为201至300个/微升的15例患者中，1例（7%）有菌血症；CD4细胞计数＞300个/微升的8例患者中均无菌血症（p = 0.002）。CD4细胞计数低的患者抗酸涂片更常呈阳性。结核菌素皮肤试验阳性在CD4细胞计数高的患者中更常见。在胸部X线片上，CD4细胞计数≤200个/微升的58例患者中有20例（34%）出现纵隔淋巴结肿大，CD4细胞计数＞200个/微升的29例患者中有4例（14%）出现纵隔淋巴结肿大（p = 0.04）。CD4细胞计数≤200个/微升的58例患者中有6例（10%）出现胸腔积液，CD4细胞计数＞200个/微升的29例患者中有8例（28%）出现胸腔积液（p = 0.04）。CD8细胞计数与结核病的表现无相关性。（摘要截短于250字）
