Darras-Joly C, Lucet J C, Laissy J P, Chochillon C, Casalino E, Joly V, Matheron S, Bouvet E
Service de Médecine Interne, Hôpital Pitié-Salpêtrière, Paris, France.
Pathol Biol (Paris). 1998 Jun;46(6):416-7.
Risk factor for invasive pulmonary aspergillosis in HIV-negative patients include neutropenia, corticosteroid therapy, and chemotherapy. Corresponding risk factors in HIV-positive patients have not yet been reported. A case-control study was conducted at the Bichat-Claude Bernard Teaching Hospital, Paris, France, between 1991 and 1996. Eight cases were identified. In three cases, the diagnosis was documented histologically. Of the remaining five patients, four had a de novo lung cavity with a positive bronchoscopy sample, and one had a pulmonary infiltrate with a positive bronchoscopy sample in the absence of any other potential pathogen. Each case was matched with three controls who were admitted during the same period and had CD4 counts lower than 50/mm3. Median age was 38.1 years in the cases and 38.4 years in the controls. Median CD4 counts were 12.5 +/- 19.2 in the cases versus 19.3 +/- 16.3 in the controls (P = 0.14). No case-control differences were found for AIDS duration, neutrophil counts at diagnosis or during the previous six months, history of corticosteroid therapy or chemotherapy, or number of previous opportunistic infections. Cases were more likely than controls to have a preexisting lung cavity (3/8 versus 0/24; P = 0.01) and had spent more time in the hospital during the previous year (7 +/- 4.5 versus 2.8 +/- 3.2 weeks; P = 0.02). These data do not support a role for neutropenia or immunosuppressive treatments as risk factors for invasive aspergillosis in AIDS. They suggest that AIDS patients with a lung cavity or frequent hospital stays are at increased risk for invasive aspergillosis.
HIV阴性患者侵袭性肺曲霉病的危险因素包括中性粒细胞减少、皮质类固醇治疗和化疗。HIV阳性患者相应的危险因素尚未见报道。1991年至1996年期间，在法国巴黎的比夏-克劳德·贝尔纳教学医院进行了一项病例对照研究。共确定了8例病例。其中3例经组织学确诊。其余5例患者中，4例有新发肺空洞且支气管镜检查样本呈阳性，1例在无任何其他潜在病原体的情况下有肺部浸润且支气管镜检查样本呈阳性。每个病例与3名同期入院且CD4细胞计数低于50/mm³的对照进行匹配。病例组的中位年龄为38.1岁，对照组为38.4岁。病例组的中位CD4细胞计数为12.5±19.2，对照组为19.3±16.3（P = 0.14）。在艾滋病病程、诊断时或前六个月的中性粒细胞计数、皮质类固醇治疗或化疗史、或既往机会性感染次数方面，病例组与对照组之间未发现差异。病例组比对照组更易有既往肺空洞（3/8比0/24；P = 0.01），且上一年在医院的住院时间更长（7±4.5周比2.8±3.2周；P = 0.02）。这些数据不支持中性粒细胞减少或免疫抑制治疗作为艾滋病患者侵袭性曲霉病危险因素的作用。它们表明有肺空洞或频繁住院的艾滋病患者发生侵袭性曲霉病的风险增加。
