Batungwanayo J, Taelman H, Allen S, Bogaerts J, Kagame A, Van de Perre P
Department of Internal Medicine, Centre Hospitalier de Kigali, Rwanda.
AIDS. 1993 Jan;7(1):73-9. doi: 10.1097/00002030-199301000-00011.
An increasing number of diagnoses of pleural effusions (PE) have been made over the last 8 years in the Department of Internal Medicine of the Centre Hospitalier de Kigali, Rwanda. In order to determine the aetiology of PE and to examine its possible association with HIV-1 infection, we performed an aetiological work-up, including thoracocentesis and pleural punch biopsy, of all new patients with PE of undetermined aetiology referred to the Division of Pulmonary Diseases of the Department of Internal Medicine of the Centre Hospitalier de Kigali between 14 September 1988 and 16 October 1989. HIV-1 serological testing was performed for most of the patients.
A total of 127 patients (81 men, 46 women; mean age, 34 years; range, 16-71 years) with PE of undetermined aetiology were enrolled. Pleural tuberculosis was diagnosed in 110 (86%) and confirmed histologically and/or bacteriologically in 90 (82%). Of 98 pleural tuberculosis patients tested for HIV-1-antibody, 82 (83%) were HIV-1-seropositive. Metastatic cancer was responsible for PE in six (5%) patients, Kaposi's sarcoma in three, lymphoma in one (all four HIV-1-seropositive), anaplastic carcinoma in one, and adenocarcinoma in one (both HIV-1-seronegative). Non-tuberculous pneumonia was documented in five (4%) patients and was associated with HIV-1 infection in four. Other causes of PE were congestive heart failure (three patients), decompensated cirrhosis (one), constrictive percarditis (one), or undetermined (one); only one of these patients was HIV-1-seropositive.
We conclude that tuberculosis is the predominant cause of PE in our patients and is strongly associated with HIV-1 infection. Although less frequent, non-tuberculous pneumonia, Kaposi's sarcoma and lymphoma are other causes of HIV-1-associated PE. In an African area highly endemic for HIV-1 and Mycobacterium tuberculosis co-infection, PE should be considered a good marker of tuberculosis as well as HIV-1 infection.
在过去8年里，卢旺达基加利中心医院内科诊断出的胸腔积液（PE）病例数不断增加。为了确定PE的病因并研究其与HIV-1感染的可能关联，我们对1988年9月14日至1989年10月16日转诊至基加利中心医院内科肺病科的所有病因不明的新发PE患者进行了病因检查，包括胸腔穿刺术和胸膜穿刺活检。对大多数患者进行了HIV-1血清学检测。
共纳入127例病因不明的PE患者（81例男性，46例女性；平均年龄34岁；范围16 - 71岁）。110例（86%）诊断为胸膜结核，其中90例（82%）经组织学和/或细菌学确诊。在98例接受HIV-1抗体检测的胸膜结核患者中，82例（83%）HIV-1血清学呈阳性。转移性癌导致PE的有6例（5%），卡波西肉瘤3例，淋巴瘤1例（这4例均为HIV-1血清学阳性），间变性癌1例，腺癌1例（这2例均为HIV-1血清学阴性）。5例（4%）患者记录为非结核性肺炎，其中4例与HIV-1感染有关。PE的其他病因包括充血性心力衰竭（3例患者）、失代偿性肝硬化（1例）、缩窄性心包炎（1例）或病因不明（1例）；这些患者中只有1例HIV-1血清学呈阳性。
我们得出结论，结核是我们患者中PE的主要病因，且与HIV-1感染密切相关。虽然频率较低，但非结核性肺炎、卡波西肉瘤和淋巴瘤是HIV-1相关PE的其他病因。在HIV-1和结核分枝杆菌共同感染高度流行的非洲地区，PE应被视为结核以及HIV-1感染的良好标志物。
