Clinical and radiographic correlates of primary and reactivation tuberculosis - A molecular epidemiology study
Clinical and radiographic correlates of primary and reactivation tuberculosis - A molecular epidemiology study
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DOI：
10.1001/jama.293.22.2740
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发表时间：
2005-06-08
影响因子：
120.7
通讯作者：
Schluger, NW
中科院分区：
文献类型：
--
作者：
Geng, E;Kreiswirth, B;Schluger, NW
背景传统的观点认为，肺结核的特征是胸部X线片上的淋巴结病变、积液和下肺或中肺区浸润，这是近期获得性感染的“原发性”疾病，而上叶浸润和空洞则是较久以前获得的继发性或再激活性疾病，这种观点并没有建立在充分的临床证据基础上。此外，目前尚不清楚人类免疫缺陷病毒（HIV）相关结核病中常见的非典型X线片是否是由于原发性疾病进展或免疫改变的优势。目的通过使用分子指纹和常规流行病学分析新近获得性肺结核和远程获得性肺结核之间的关系，临床和人口统计学变量，以及X线片特征。一项回顾性的、以医院为基础的系列研究，包括1990年至1999年间在纽约市医疗中心接受治疗的456例患者。符合条件的患者必须有至少1个阳性的呼吸道结核分枝杆菌培养和可用的放射学data.Main结果测量放射学表现的存在或不存在的6个功能：上叶浸润，空洞病变，腺病，积液，下或中肺区浸润，和粟粒型。无论是否存在其他特征，如果有上叶浸润或空洞，则认为X线片是典型的。结果人类免疫缺陷病毒感染是最常见的与一个不典型的X线表现在胸片上的优势比为0.20（95%可信区间，0.13-0.31）。虽然聚类指纹，代表最近获得的疾病，与典型的X光片在单变量分析（比值比，0.68; 95%置信区间，0.47-0.99），调整HIV状态时，该协会丢失。结论时间从收购的感染到发展的临床疾病并不能可靠地预测，结核病的放射学表现。人类免疫缺陷病毒状态是宿主免疫反应完整性的可能替代物，是影像学表现的唯一独立预测因子。HIV感染者肺结核影像学表现的改变是由于免疫力改变，而不是近期感染和进展为活动性疾病。
Context The traditional teaching that pulmonary tuberculosis characterized by lymphadencipathy, effusions, and lower or mid lung zone infiltrates on chest radiography represents "primary" disease from recently acquired infection, whereas upper lobe infiltrates and cavities represent secondary or reactivation disease acquired in the more distant past, is not based on well-established clinical evidence. Furthermore, it is not known whether the atypical radiograph common in human immunodeficiency virus (HIV)-associated tuberculosis is due to a preponderance of primary progressive disease or altered immunity.Objective To analyze the relationship between recently acquired and remotely acquired pulmonary tuberculosis, clinical and demographic variables, and radiographic features by using molecular fingerprinting and conventional epidemiology.Design, Setting, and Population A retrospective, hospital-based series of 456 patients treated at a New York City medical center between 1990 and 1999. Eligible patients had to have had at least 1 positive respiratory culture for Mycobacterium tuberculosis and available radiographic data.Main Outcome Measures Radiographic appearance as measured by the presence or absence of 6 features: upper lobe infiltrate, cavitary lesion, adenopathy, effusions, lower or mid lung zone infiltrate, and miliary pattern. Radiographs were considered typical if they had an upper lobe infiltrate or cavity whether or not other features were present. Atypical radiographs were those that had adenopathy, effusion, or mid lower lung zone infiltrates or had none of the above features.Results Human immunodeficiency virus infection was most commonly associated with an atypical radiographic appearance on chest radiograph with an odds ratio of 0.20 (95% confidence interval, 0.13-0.31). Although a clustered fingerprint, representing recently acquired disease, was associated with typical radiograph in univariate analysis (odds ratio, 0.68; 95% confidence interval, 0.47-0.99), the association was lost when adjusted for HIV status.Conclusions Time from acquisition of infection to development of clinical disease does not reliably predict the, radiographic appearance of tuberculosis. Human immunodeficiency virus status, a probable surrogate for the integrity of the host immune response, is the only independent predictor of radiographic appearance. The altered radiographic appearance of pulmonary tuberculosis in HIV is due to altered immunity rather than recent acquisition of infection and progression to active disease.