RADIOGRAPHIC FINDINGS IN HIV-POSITIVE PATIENTS WITH SENSITIVE AND RESISTANT TUBERCULOSIS
RADIOGRAPHIC FINDINGS IN HIV-POSITIVE PATIENTS WITH SENSITIVE AND RESISTANT TUBERCULOSIS
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DOI：
10.1378/chest.106.3.687
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发表时间：
1994-09-01
期刊：
影响因子：
9.6
通讯作者：
TALAVERA, W
中科院分区：
文献类型：
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作者：
LESSNAU, KD;GORLA, M;TALAVERA, W
为了促进对hiv阳性患者耐多药结核分枝杆菌（MTB）疾病的早期识别，我们评估了纽约市一家三级保健中心72名患者的胸部x线片。敏感型结核分枝杆菌33例，单耐药（SDR）型结核分枝杆菌3例，多耐药（MDR）型结核分枝杆菌36例。回顾所有胸部x线片，并将其与药物敏感性、其他诊断结果和临床病程联系起来。三组患者在初始表现上的影像学差异无统计学意义（p < 0.05）。12例发现空腔，23例发现上肺叶病变，15例发现下肺叶病变，30例发现可能的胸内淋巴结病变，12例发现弥漫性浸润，13例发现胸腔积液，3例发现军事性病变。10例胸部x线片正常。治疗2周后，35名耐多药结核患者中有20人出现新的积液，可能是胸内淋巴结病变，或浸润恶化。随着病情恶化，在我们的病例对照研究中，耐多药MTB的概率为95%。因此，对于治疗2周后胸片显示病情恶化的hiv阳性患者，调整抗结核治疗是合理的。
To facilitate early recognition of multi-drug resistant (MDR) Mycobacterium tuberculosis (MTB) disease in HIV-positive patients we evaluated the chest x-ray films of 72 patients in a tertiary care center in New York City. Thirty-three patients had sensitive MTB, 3 had single-drug resistant (SDR) MTB, and 36 patients had multidrug resistant (MDR) MTB. All chest x-ray films were reviewed and correlated with drug sensitivities, additional diagnostic results, and clinical courses. There were no significant radiographic differences among the 3 groups on initial presentation (p>0.05). Cavities were found in 12 patients, upper lobe disease in 23, lower lobe disease in 15, possible intrathoracic lymphadenopathy in 30, diffuse infiltrates in 12, pleural effusion in 13, and a miliary pattern in 3 patients. Normal chest x-ray films were found in ten patients. After 2 weeks of therapy, 20 out of 35 MDR-MTB patients developed new effusions, possible intrathoracic lymphadenopathy, or worsening infiltrates. With deterioration, the probability of MDR MTB was 95 percent in our case control study. Thus, it would be reasonable to adjust antituberculosis therapy in HIV-positive patients with deteriorating conditions shown on chest x-ray films after 2 weeks of therapy.