Caylà J A, Jansà J M, Artazcoz L, Plasència A
S. d'Epidemiologia, Institut Municipal de la Salut, Barcelona, Spain.
Tuber Lung Dis. 1993 Apr;74(2):113-20. doi: 10.1016/0962-8479(93)90037-x.
We estimated the cumulative probability of AIDS in a cohort of 191 HIV-positive patients with pulmonary or pleural tuberculosis, as well as the role of age, sex, district of residence, risk group, alcoholism, homelessness, prison history, site of tuberculosis, radiology, tuberculin skin test and lymphocyte subsets as predictive factors for AIDS development. The 1 year cumulative probability of AIDS for all patients was 27.7% (95% CI:21.7-35.0) and 38.6% (95% CI:31.5-46.7) at 2 years. In the univariate analysis (Kaplan Meier method) the following categories were associated with a higher probability of AIDS: older age group (P = 0.014), exclusively homosexual risk group (P = 0.005), radiology without cavitary pattern (P < 0.001), negative tuberculin skin test (P < 0.001), low CD4 percentage (P = 0.068) and low CD4-CD8 ratio (P = 0.002). At the multivariate level (Cox method), older age group (risk ratio = 24.45, 95% CI = 2.1-286.1), radiology without cavitary pattern (risk ratio = 15.68, 95% CI = 1.1-211.0), and low CD4-CD8 ratio (risk ratio = 50.77, 95% CI = 3.9-645.0) were associated with a higher probability of AIDS. A positive tuberculin skin test had a protective effect (risk ratio = 0.009, 95% CI = 0.01-0.61). Findings from this cohort study suggest that pulmonary and/or pleural tuberculosis in HIV infected patients should be seriously considered as criteria for AIDS when a negative tuberculin skin test and/or low T4/T8 ratio is present, especially in older people without cavitary radiologic pattern.
我们估算了191名合并肺部或胸膜结核的HIV阳性患者发生艾滋病的累积概率，以及年龄、性别、居住地区、风险组、酗酒、无家可归、服刑史、结核部位、放射学检查结果、结核菌素皮肤试验和淋巴细胞亚群作为艾滋病发病预测因素的作用。所有患者1年时艾滋病的累积概率为27.7%（95%置信区间：21.7 - 35.0），2年时为38.6%（95%置信区间：31.5 - 46.7）。在单因素分析（Kaplan - Meier法）中，以下类别与艾滋病发生概率较高相关：年龄较大组（P = 0.014）、仅为同性恋风险组（P = 0.005）、无空洞型放射学表现（P < 0.001）、结核菌素皮肤试验阴性（P < 0.001）、CD4百分比低（P = 0.068）以及CD4 - CD8比值低（P = 0.002）。在多因素水平（Cox法）上，年龄较大组（风险比 = 24.45，95%置信区间 = 2.1 - 286.1）、无空洞型放射学表现（风险比 = 15.68，95%置信区间 = 1.1 - 211.0）以及CD4 - CD8比值低（风险比 = 50.77，95%置信区间 = 3.9 - 645.0）与艾滋病发生概率较高相关。结核菌素皮肤试验阳性具有保护作用（风险比 = 0.009，95%置信区间 = 0.01 - 0.61）。这项队列研究的结果表明，当结核菌素皮肤试验阴性和/或T4/T8比值低时，尤其是在无空洞型放射学表现的老年人中，HIV感染患者的肺部和/或胸膜结核应被认真视为艾滋病的诊断标准。
