艾滋病并发结核相关免疫重建炎性反应综合征的胸部CT影像表现及与CD4+T淋巴细胞水平的相关性

Chest CT Imaging Features of AIDS Complicated with Tuberculosis-Associated Immune Reconstitution Inflammatory Response Syndrome and Its Correlation with CD4+Tlymphocyte Level

目的分析获得性免疫缺陷综合征(AIDS)并发结核相关免疫重建炎性反应综合征(TB-IRIS)的胸部CT影像表现及其与CD4+T淋巴细胞计数的相关性。方法选取行高效反转录病毒治疗(HAART)并经临床确诊或病理及实验室检查证实的AIDS并发TB-IRIS的胸部结核患者45例作为研究对象,收集其CT影像征象及CD4+T淋巴细胞计数资料。将研究对象分为两型:暴露TB-IRIS(Ⅰ型)和矛盾TB-IRIS(Ⅱ型);分析两型的CT影像征象与CD4+T淋巴细胞计数的相关性。结果AIDS并发胸部TB-IRIS表现为纵隔淋巴结结核38例(84.4%,38/45)、血行播散性肺结核29例(64.4%,29/45)及继发性肺结核25例(55.6%,25/45),伴发肺外结核26例(57.8%,26/45)。暴露TB-IRIS 17例(37.8%,17/45),矛盾TB-IRIS 28例(62.2%,28/45),两型比较IRIS发生时间间隔、血行播散性肺结核发生率具有统计学意义(P<0.05);CT影像征象表现为段性或亚段性实变、磨玻璃渗出影、支气管播散及多发结节,发生率分别为55.5%(25/48)、31.1%(14/45)、51.1%(23/45)及64.4%(29/45)。与基线影像学资料对比,血行播散性肺结核、胸腔积液及心包积液差异具有统计学意义(P<0.05)。结论AIDS并发胸部TB-IRIS患者多为青壮年、男性,86.7%(39/45)的患者CD4+T淋巴细胞计数<50×106/L,胸部CT影像主要表现为急性血行播散性肺结核、纵隔淋巴结结核、肺段性或亚段性实变、胸腔积液及心包积液,在HAART以及抗结核治疗后,病变先进展后吸收的影像学变化具有特异性,常合并肺外结核,结合临床及实验室检查有助于提高TB-IRIS诊断的准确性。

Objective To analyze chest CT imaging manifestations of tuberculosis-associated immune reconstruction inflammatory syndrome(TB-IRIS)and its correlation with CD4+T lymphocyte count in acquired immunodeficiency syndrome(AIDS)patients.Methods 45 AIDS patients with TB-IRIS who were hospitalized and treated withhighly active antiretroviral therapy(HAART)in our hospital and confirmed by clinical diagnosis or pathology and laboratory examination were selected as the research subjects,and their CT imaging signs and CD4+T lymphocyte count data were collected.Subjects were divided into two types:exposed TB-IRIS(type I)and contradictory TB-IRIS(type II),and the correlation between CT images of the two types and CD4+T lymphocyte count was analyzed.Results There were 38 cases with chest TB-IRIS(84.4%,38/45)which presented as tuberculosis of mediastinal lymph nodes,29 cases(64.4%,29/45)of hematogenous disseminated tuberculosis,25 cases(55.5%,25/45)of secondary tuberculosis,and 26 cases(57.8%,26/45)of extrapulmonary tuberculosis.17 cases(37.8%,17/45)were exposed TB-IRIS,and 28 cases(62.2%,28/45)were contradictory TB-IRIS.The time interval between IRIS and the incidence of hematogenous disseminated tuberculosis were statistically significant(P<0.05).The CT findings showed segmental or subsegmental consolidation,ground glass effusion,bronchial diffusion and multiple nodules in 55.5%(25/48),31.1%(14/45),51.1%(23/45)and 64.4%(29/45),respectively.Compared with the baseline imaging data,there were statistical differences in hematopoietic disseminated tuberculosis,pleural effusion and pericardial effusion(P<0.05).Conclusion Thoracic TB-IRIS in AIDS patients were more common for young male adults.86.7%(39/45)of patients with CD4+T lymphocyte count<50×106/L,and chest CT images mainly reveal acute hematopoietic disseminated tuberculosis,mediastinal lymph node tuberculosis,segmental or subsegmental consolidation,and pleural effusion and pericardial effusion.After HAART and anti-tuberculosis treatment,changes of lesion progress before absorption imaging have specificity.Accompanying extra-pulmonary tuberculosis is common in these patients.Combination of CT imaging with clinical and laboratory examination will help to improve the accuracy of TB-IRIS diagnosis.