Luzzati R, Cazzadori A, Malena M, Mazzi R, Danzi M C, Ciaffoni S, Concia E, Bassetti D
Istituto di Malattie Infettive, Università di Verona.
Minerva Med. 1993 Mar;84(3):95-101.
The aim of this retrospective study is to evaluate the correlation between T-cell immunity and pulmonary disorders in a group of Italian subjects with HIV infection. HIV-infected patients seen at the Institute of Infectious Diseases, University of Verona, were included in this study if they had a specific acute pneumonia, a CD4+ cell count and a CD4+/CD8+ ratio during the 60 days immediately before the onset of pulmonary disease. Cases receiving any antimicrobial prophylaxis were excluded. Pneumonia was recognized by usual clinical and radiologic abnormalities. The diagnostic procedure included sputum examination, bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. The specimens were processed for bacterial, mycobacterial and fungal stains and cultures. Ziehl-Neelsen, periodic acid-Schiff and silver methenamine stains were performed on the transbronchial biopsy specimens in addition to usual pathologic examinations mononuclear. Determination of percentage of peripheral blood mononuclear cells bearing CD4+ and CD8+ markers was done by conventional fluorescent antibody cell-sorter analysis of the mononuclear cell population. Absolute number of CD4+ lymphocytes was determined by multiplying the total lymphocyte count by the percent of mononuclear cells bearing CD4+ marker. From October 1987 to August 1991, 61 patients, 50 males and 11 females, had 65 episodes of specific pneumonia. The average age of patients was 31.4 years (range 29-59 years). The risk factors for HIV infection included intravenous drug abuse (47 patients), homosexuality (6 patients), bisexuality (3 patients) and heterosexual contact (5 patients). Before the onset of pulmonary disorders, patients were classified in the following clinical HIV-related stages: asymptomatic state (22 episodes), ARC (22 episodes) and AIDS (21 episodes). In decreasing order of frequency diagnosis of pneumonias were PCP (29 episodes), community-acquired bacterial pneumonia (16 episodes), pulmonary tuberculosis (8 episodes), nonspecific interstitial pneumonia (4 episodes), PCP and pulmonary tuberculosis (3 episodes), cytomegalovirus pneumonia (2 episodes), and one of each episode of PCP and pulmonary cryptococcosis, pulmonary candidiasis, pulmonary Kaposi's sarcoma. The mean and the standard deviation of immunologic values regarding the four primary diagnostic groups were: PCP CD4+/CD8+ 0.50 +/- 0.42, CD4+/mm3 196 +/- 190; bacterial pneumonia CD4+/CD8+ 0.53 +/- 0.44, CD4+/mm3 247 +/- 139; pulmonary tuberculosis CD4+/CD8+ 0.62 +/- 0.38, CD4+/mm3 260 +/- 170; nonspecific interstitial pneumonia CD4+/CD8 + 0.57 +/- 0.48, CD4+/mm3 240 +/- 189. No significant statistical differences with respect to CD4+/CD8 ratios and CD4+ cell counts among these diagnostic groups were found by standard analysis of variance.(ABSTRACT TRUNCATED AT 400 WORDS)
这项回顾性研究的目的是评估一组意大利HIV感染患者的T细胞免疫与肺部疾病之间的相关性。如果维罗纳大学传染病研究所的HIV感染患者在肺部疾病发作前60天内有特定的急性肺炎、CD4 +细胞计数和CD4 + / CD8 +比值，则纳入本研究。接受任何抗菌预防的病例被排除。肺炎通过常规临床和放射学异常来识别。诊断程序包括痰检查、支气管镜检查及支气管肺泡灌洗和经支气管活检。对标本进行细菌、分枝杆菌和真菌染色及培养。除了常规的单核细胞病理检查外，对经支气管活检标本进行齐-尼氏染色、过碘酸-希夫染色和六胺银染色。通过对单核细胞群体进行常规荧光抗体细胞分选分析来确定携带CD4 +和CD8 +标志物的外周血单核细胞百分比。CD4 +淋巴细胞的绝对数量通过将总淋巴细胞计数乘以携带CD4 +标志物的单核细胞百分比来确定。从1987年10月到1991年8月，61例患者（50例男性和11例女性）发生了65次特定肺炎发作。患者的平均年龄为31.4岁（范围29 - 59岁）。HIV感染的危险因素包括静脉药物滥用（47例患者）、同性恋（6例患者）、双性恋（3例患者）和异性接触（5例患者）。在肺部疾病发作前，患者被分类为以下与HIV相关的临床阶段：无症状状态（22次发作）、艾滋病相关综合征（22次发作）和艾滋病（21次发作）。按频率递减顺序，肺炎的诊断依次为肺孢子菌肺炎（29次发作）、社区获得性细菌性肺炎（16次发作）、肺结核（8次发作）、非特异性间质性肺炎（4次发作）、肺孢子菌肺炎和肺结核（3次发作）、巨细胞病毒肺炎（2次发作），以及各1次发作的肺孢子菌肺炎和肺隐球菌病、肺念珠菌病、肺卡波西肉瘤。四个主要诊断组的免疫值的平均值和标准差为：肺孢子菌肺炎CD4 + / CD8 + 0.50±0.42，CD4 + / mm3 196±190；细菌性肺炎CD4 + / CD8 + 0.53±0.44，CD4 + / mm3 247±139；肺结核CD4 + / CD8 + 0.62±0.38，CD4 + / mm3 260±170；非特异性间质性肺炎CD4 + / CD8 + 0.57±0.48，CD4 + / mm3 （文档此处似乎有误，应为240±189）。通过方差标准分析，在这些诊断组之间未发现CD4 + / CD8比值和CD4 +细胞计数有显著统计学差异。（摘要截断于400字）
