Foresti V, Villa A, De Filippi G, Numeroso R
III Divisione di Medicina Generale, Ospedale Fatebenefratelli, Milano.
Recenti Prog Med. 1994 Jun;85(6):323-7.
A reduction in the Dco has been frequently found in intravenous drug addicts (IVDAs) and in subjects with HIV infection. Since also cigarette smoking decreases Dco, we studied a group of street IVDAs, who did not show respiratory symptoms and/or infiltrates on chest x-ray film. Sixty-two patients were presently smoking, 2 had never smoked. Twenty-seven were HIV-negative and 37 HIV-positive. Mean values for Dco (percent of predicted values) were 78 +/- 16.4 in HIV-positives compared to 97.9 +/- 17.6 in HIV-negatives (p < 0.0001) using smoking specific equations and 71.8 +/- 15.4 in HIV-positives compared to 80.7 +/- 13.4 (p < 0.0001) using non-smokers equations. Dco was < 80 percent in 19 of 35 (54.3%) HIV-positive subjects and in 4 of 26 (15.4%) HIV-negative subjects (p < 0.009) using predicted values for smokers, and in 28 of 35 (80%) HIV-positive subjects and in 6 of 26 (23.1%) HIV-negative subjects (p < 0.0001) using predicted values for non-smokers. These data suggest that Dco alterations observed in HIV-positive subjects are due, in absence of respiratory symptoms and/or chest x-ray abnormalities, to an interstitial pneumopathy due to HIV or to a subclinical pulmonary disease. We conclude that the knowing of smoking in IVDAs is useful, but the knowing of seropositivity is much more important, since a marked reduction of Dco in these subjects suggests an HIV-related lymphocytic alveolitis, an opportunistic infection or a malignancy.
在静脉注射吸毒者（IVDAs）和感染艾滋病毒的受试者中，常发现一氧化碳弥散量（Dco）降低。由于吸烟也会降低Dco，我们研究了一组街头IVDAs，他们没有呼吸道症状和/或胸部X光片上没有浸润影。62名患者目前吸烟，2名从不吸烟。27名艾滋病毒阴性，37名艾滋病毒阳性。使用吸烟特异性方程时，艾滋病毒阳性者的Dco（预测值百分比）平均值为78±16.4，而艾滋病毒阴性者为97.9±17.6（p<0.0001）；使用非吸烟者方程时，艾滋病毒阳性者为71.8±15.4，而艾滋病毒阴性者为80.7±13.4（p<0.0001）。使用吸烟者预测值时，35名艾滋病毒阳性受试者中有19名（54.3%）Dco<80%，26名艾滋病毒阴性受试者中有4名（15.4%）（p<0.009）；使用非吸烟者预测值时，35名艾滋病毒阳性受试者中有28名（80%），26名艾滋病毒阴性受试者中有6名（23.1%）（p<0.0001）。这些数据表明，在没有呼吸道症状和/或胸部X光异常的情况下，艾滋病毒阳性受试者中观察到的Dco改变是由于艾滋病毒引起的间质性肺病或亚临床肺部疾病。我们得出结论，了解IVDAs中的吸烟情况是有用的，但了解血清阳性更为重要，因为这些受试者中Dco的显著降低表明存在与艾滋病毒相关的淋巴细胞性肺泡炎、机会性感染或恶性肿瘤。
