Hsieh S M, Hung C C, Chen M Y, Hsueh P R, Chang S C, Luh K T
Department of Internal Medicine, National Taiwan University Hospital, Taipei.
AIDS. 1998 Jul 30;12(11):1301-7. doi: 10.1097/00002030-199811000-00011.
To describe and compare the clinical features and outcome of disseminated tuberculosis (TB) and Mycobacterium avium complex (MAC) disease in AIDS patients.
Prospective cohort study.
A 1800-bed university teaching hospital, the largest centre for HIV/AIDS patients in Taiwan.
From July 1994 through June 1997, a standardized protocol was used to record the demographic and clinical features in all hospitalized HIV-infected patients, and to perform routine studies and invasive procedures for diagnosis of disseminated mycobacterial diseases. To compare the survival, control patients were selected from the HIV-infected patients hospitalized in the same hospital during the same study period, and had similar age, sex, CD4+ cell counts and antiretroviral therapy regimens.
A total of 22 cases of disseminated TB and 15 cases of disseminated MAC were identified. Disseminated TB and MAC occurred in patients with similarly low CD4+ cell counts (median, 23 versus 5 x 10(6)/l; P = 0.08). The clinical features favouring disseminated TB included night sweats, peripheral lymphadenopathy, acid-fast bacilli in sputum smears, chest radiographic findings of hilar enlargement, and lack of prior AIDS-defining illnesses. Hepatosplenomegaly, elevated serum alkaline phosphatase (more than twice the upper limit of normal), elevated serum gamma-glutamyl transpeptidase (more than three times the upper limit of normal), and leukopenia favoured disseminated MAC. The patients with disseminated TB survived much longer than patients with disseminated MAC (mean survival, 96 versus 22 weeks, P = 0.008) but had a similar outcome to control patients (P = 0.60).
Disseminated TB and MAC are distinguishable by clinical features in AIDS patients with similar immunocompromised states. Those features may facilitate diagnosis and selection of specific therapeutic regimens. Disseminated TB was not associated with a shortened survival period in AIDS patients when they completed anti-TB treatment. In contrast, disseminated DMAC was associated with shortened survival despite treatment with potent regimens. These results may emphasize the importance of prophylaxis for MAC in this population.
描述并比较艾滋病患者播散性结核病（TB）和鸟分枝杆菌复合群（MAC）病的临床特征及预后。
前瞻性队列研究。
一家拥有1800张床位的大学教学医院，台湾最大的HIV/AIDS患者诊疗中心。
1994年7月至1997年6月，采用标准化方案记录所有住院HIV感染患者的人口统计学和临床特征，并进行常规检查及侵入性操作以诊断播散性分枝杆菌病。为比较生存率，从同一研究期间在同一家医院住院的HIV感染患者中选取对照患者，这些对照患者年龄、性别、CD4+细胞计数及抗逆转录病毒治疗方案相似。
共确诊22例播散性TB和15例播散性MAC。播散性TB和MAC发生于CD4+细胞计数同样低的患者（中位数分别为23与5×10⁶/L；P = 0.08）。提示播散性TB的临床特征包括盗汗、外周淋巴结病、痰涂片抗酸杆菌、胸部X线片显示肺门增大以及无先前的艾滋病界定疾病。肝脾肿大、血清碱性磷酸酶升高（超过正常上限两倍）、血清γ-谷氨酰转肽酶升高（超过正常上限三倍）及白细胞减少提示播散性MAC。播散性TB患者的存活时间比播散性MAC患者长得多（平均生存时间分别为96周与22周，P = 0.008），但与对照患者的预后相似（P = 0.60）。
在免疫功能同样低下的艾滋病患者中，播散性TB和MAC可通过临床特征加以区分。这些特征可能有助于诊断及选择特定的治疗方案。艾滋病患者完成抗结核治疗后，播散性TB与生存期缩短无关。相比之下，尽管采用强效方案治疗，播散性MAC仍与生存期缩短有关。这些结果可能凸显了对该人群进行MAC预防的重要性。
