艾滋病合并肺结核与单纯性肺结核胸部CT特征及其对临床诊断价值分析

Chest CT features of HIV/AIDS-complicated pulmonary tuberculosis and simple tuberculosis and its clinical diagnostic value

目的比较分析艾滋病合并肺结核与单纯性肺结核患者胸部CT特征,旨在为艾滋病合并肺结核患者临床诊断提供理论依据。方法收集2012年4月~2017年6月经新疆维吾尔自治区胸科医院确诊的64例艾滋病合并肺结核(合并组)患者胸部CT影像学资料进行回顾性分析,并与同期收治的64例单纯性肺结核(单纯性组)患者胸部CT影像学资料进行对比,比较两组患者病变部位及其范围、CT影像学特征,运用SPSS统计软件处理分析。结果①2组在性别构成比、年龄、临床症状等方面比较差异无统计学意义(P>0.05);②病变部位、范围:艾滋病合并肺结核组病变部位在双肺上叶或双肺下叶的比例显著高于单纯性肺结核组,其差异有显著统计学意义(P<0.05);艾滋病合并肺结核组多为两叶及两叶以上受累,且多累及胸膜或淋巴结,而单纯性肺结核组多为单叶受累,累及胸膜或淋巴结相对较少,其差异比较均有显著统计学意义(P<0.05);两组病变同时累及肺上、下叶者比较差异不显著(P>0.05)。③胸部CT表现:多发结节影、空洞、钙化等表现方面艾滋病合并肺结核组显著少于单纯性肺结核组,差异比较有显著统计学意义(P<0.05);而斑片或大片状实变影、纵隔淋巴结增大、心包积液、胸膜腔积液等表现方面艾滋病合并肺结核组显著多于单纯性肺结核组,其差异比较有显著统计学意义(P<0.05);两组在条索影及粟粒影等表现方面比较无差异(P>0.05)。结论AIDS合并肺结核患者胸部CT影像学特征多不典型,复杂而多变,但病变累及范围较为广泛,与单纯性肺结核相较,更多的是表现为多肺叶受累、出现斑片或大片状实变影、纵隔淋巴结增大、心包腔或胸膜腔积液等,对其诊断具有一定的鉴别价值。

Objective To compare and analyze the features of chest CT in patients with AIDS complicated with tuberculosis and simple tuberculosis and to provide a theoretical basis for the clinical diagnosis of AIDS with tuberculosis..Methods Thoracic CT images of 64 cases of AIDS complicated with pulmonary tuberculosis complicated with pulmonary tuberculosis confirmed by our hospital from April 2012 to June 2017 were retrospectively analyzed and compared with the chest CT data of 64 cases of simple tuberculosis(simple group)in the same period,the lesion location and extent of the two groups of patients were compared,and CT imaging features were analyzed and analyzed by SPSS statistical software.Results①There was no significant difference in the sex ratio,age,clinical symptoms between the two groups(P>0.05).②The location and range of the lesions:The proportion of lesions in the upper pulmonary or lower lung(P<0.05).In HIV/AIDS patients with pulmonary tuberculosis,most of them were affected by two or more leaves and more than two lobes,and pleural or lymph nodes were more common in patients with simplex tuberculosis than those with simple pulmonary tuberculosis There were significant differences between the two groups(P<0.05).There was no significant difference between the two groups in lesions involving the upper and lower lobe(P>0.05).③Chest CT manifestations:multiple nodules,cavities,calcification and other aspects of AIDS with tuberculosis was significantly less than that of simple tuberculosis group,the difference was statistically significant(P<0.05);and patch or large plate-like consolidation(P<0.05).There was significant difference between the two groups in terms of cords,mediastinal lymph node enlargement,pericardial effusion,pleural effusion and other manifestations of AIDS with pulmonary tuberculosis was significantly more than that of simple tuberculosis group.There was no difference between the two groups in strip shadow and millet shadow(P>0.05).Conclusion The CT features of chest CT in AIDS patients with pulmonary tuberculosis are mostly atypical,complicated and changeable,but the range of their involvement is rather wide.Compared with simple pulmonary tuberculosis,CT images of the patients with AIDS complicated with pulmonary tuberculosis are mostly characterized by multiple lobe involvement,patchy or flaky consolidation of the mediastinal mediastinal lymph nodes increased,pericardial or pleural effusion,etc.,it has certain differential value for its diagnosis.