RELATIONSHIP OF THE MANIFESTATIONS OF TUBERCULOSIS TO CD4 CELL COUNTS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION
RELATIONSHIP OF THE MANIFESTATIONS OF TUBERCULOSIS TO CD4 CELL COUNTS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION
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DOI：
10.1164/ajrccm/148.5.1292
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发表时间：
1993-11-01
期刊：
影响因子：
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通讯作者：
BARNES, PF
中科院分区：
文献类型：
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作者：
JONES, BE;YOUNG, SMM;BARNES, PF
为探讨HIV感染者结核病的临床表现与CD_4细胞计数的关系，对97例HIV感染者结核病的临床和实验室特征进行了分析。43例患者中30例（70%）CD 4细胞/μ L ≤ 100，20例患者中10例（50%）CD 4细胞/μ L 101 ~ 200，16例患者中7例（44%）CD 4细胞/μ L 201 ~ 300，18例患者中有5例（28%）CD 4细胞> 300个/μ L（p = 0.02）。在37例小于或等于100个CD 4细胞/μ L的患者中发现了18例（49%）分枝杆菌血症，15例101至200个CD 4细胞/μ L的患者中发现了3例（20%）分枝杆菌血症，15例201至300个CD 4细胞/μ L的患者中发现了1例（7%）分枝杆菌血症，8例> 300个CD 4细胞/μ L的患者中未发现分枝杆菌血症（p = 0.002）。CD 4细胞计数低的患者的抗酸涂片更常呈阳性。结核菌素皮肤试验阳性在CD 4计数高的患者中更常见。在胸部X线片上，58例患者中有20例（34%）的CD 4细胞小于或等于200个/μ L，29例患者中有4例（14%）的CD 4细胞> 200个/μ L（p = 0.04）。在58例CD 4细胞/μ L> 200的患者中有6例（10%）观察到胸腔积液，在29例CD 4细胞/μ L> 200的患者中有8例（28%）观察到胸腔积液（p = 0.04）。CD 8细胞计数与结核病临床表现无关。我们的结论是，在艾滋病毒感染患者中，严重结核病的标志物，例如分支杆菌血症和抗酸涂片阳性，在CD 4细胞计数较低的患者中更常见。依赖于迟发型超敏反应的特征，如结核菌素皮肤试验阳性和结核性胸膜炎，在CD 4细胞计数较高的患者中更常见。这些发现表明，CD 4细胞在限制结核病的严重程度方面发挥着核心作用。
To evaluate the relationship between the clinical presentation of tuberculosis and the CD4 cell count in patients with hu man immunodeficiency virus (HIV) infection, we evaluated clinical and laboratory features of 97 HIV-infected patients with tuberculosis in whom CD4 cell counts were available. Extrapulmonary tuberculosis was found in 30 (70%) of 43 patients with less than or equal to 100 CD4 cells/mu L, 10 (50%) of 20 patients with 101 to 200 CD4 cells/mu L, seven (44%) of 16 patients with 201 to 300 CD4 cells/mu L, and five (28%) of 18 patients with > 300 CD4 cells/mu L (p = 0.02). Mycobacteremia was found in 18 (49%) of 37 patients with less than or equal to 100 CD4 cells/mu L, three (20%) of 15 patients with 101 to 200 CD4 cells/mu L, one (7%) of 15 patients with 201 to 300 CD4 cells/mu L, and none of eight patients with > 300 CD4 cells/mu L (p = 0.002). Acid-fast smears were more often positive in patients with low CD4 cell counts. Positive tuberculin skin tests were more common in patients with high CD4 counts. On chest roentgenograms, mediastinal adenopathy was noted in 20 (34%) of 58 patients with less than or equal to 200 CD4 cells/mu L and four (14%) of 29 patients with > 200 CD4 cells/mu L (p = 0.04). Pleural effusions were noted in six (10%) of 58 patients with > 200 CD4 cells/mu L and eight (28%) of 29 patients with > 200 CD4 cells/mu L (p = 0.04). The CD8 cell counts did not correlate with the manifestations of tuberculosis. We conclude that, in HIV-infected patients, markers of severe tuberculosis, such as mycobacteremia and positive acid-fast smears, are more common in those with low CD4 cell counts. Features dependent on delayed-type hypersensitivity responses, such as positive tuberculin skin tests and tuberculous pleuritis, are more common in patients with higher CD4 cell counts. These findings suggest that CD4 cells play a central role in limiting the severity of tuberculosis.