Small P M, Hopewell P C, Schecter G F, Chaisson R E, Goodman P C
Medical Service, San Francisco General Hospital Medical Center, California.
J Thorac Imaging. 1994 Spring;9(2):74-7. doi: 10.1097/00005382-199421000-00003.
A large number of patients with coexisting tuberculosis and HIV infection has been reported. The chest radiographic findings are well described and primarily consist of bilateral, medium-to-coarse reticulonodular opacities often associated with hilar and mediastinal adenopathy. The evolution of chest radiographic abnormalities following treatment for tuberculosis in patients with HIV infection has not been previously studied. Initial and follow-up chest films of 33 patients with tuberculosis and HIV infection were evaluated. All 25 patients whose only pulmonary infection was tuberculosis exhibited radiographic improvement after appropriate treatment. In 8 patients, the chest radiograph worsened while on tuberculosis therapy. In each of these individuals, a newly acquired nontuberculous pulmonary disease was diagnosed as the cause of radiographic deterioration. We conclude that chest radiographs in patients with tuberculosis and HIV-infection will improve with appropriate tuberculosis therapy. Worsening of the chest radiograph does not suggest a poor therapeutic response, but instead indicates the presence of another pulmonary disease.
已有大量关于结核病与HIV感染并存患者的报道。胸部X线表现已有详尽描述，主要为双侧中至粗网状结节状阴影，常伴有肺门和纵隔淋巴结肿大。此前尚未对HIV感染患者抗结核治疗后胸部X线异常的演变情况进行研究。对33例结核病合并HIV感染患者的初始和随访胸部X线片进行了评估。仅患有肺结核的25例患者经适当治疗后，胸部X线表现均有改善。8例患者在抗结核治疗期间胸部X线片表现恶化。在这些患者中，每例均诊断出一种新获得的非结核性肺部疾病为X线恶化的原因。我们得出结论，结核病合并HIV感染患者经适当的抗结核治疗后，胸部X线片会有所改善。胸部X线片恶化并不意味着治疗反应不佳，而是提示存在另一种肺部疾病。
