免疫功能低下患者肺结核的影像诊断

Imaging Diagnosis of Patients with Pulmonary Tuberculosis in Immune Hypofunction

目的探讨几种免疫功能低下疾病并发肺结核患者的X线和CT所见。包括糖尿病、肾病综合症、系统性红斑狼疮（SLE）和获得性免疫缺陷综合症（AIDS）合并肺结核。方法回顾分析合并肺结核糖尿病患者68例，肾病综合症患者20例．SLE患者12例，AIDS患者8例X线及胸部CT所见。结果X线和CT表现，糖尿病合并肺结核：大片浸润病灶45例．浸润病灶内多发空洞40例，散在大小不等浸润病灶可不按肺段分布23例，支气管播散病灶21例；部分病例合并胸水10例。肾病综合症或SLE：急性血行播散性肺结核15例，大小不等浸润病灶17例，合并肺门及纵膈淋巴结肿大4例；AIDS合并肺结核；肺内斑片阴影合并有淋巴结肿大5例，急性血行播散性肺结核合并有淋巴结肿大3例。结论免疫功能低下疾病并发肺结核时，肺内结核病灶容易形成大片干酪病灶并合并空洞，结核肺内播散，急性血行播散性肺结核，肺门及纵膈淋巴结肿大及非结核好发部位发生浸润结核灶。

Objective To evaluate X-ray and CT features of patients with pulmonary tuberculosis in diabetic, dropsical nephritis, systemic lupus erythematosus（SLE）, and acquired immunodeficiency syndrome（AIDS）. Methods We retrospectively analysed CT scans and X-ray features in 68 cases with diabetes,20 with dropsical nephritis,12 with SLE,and 8 with AIDS. Results X-ray and CT features of pulmonary tuberculosis in diabetes included larger infiltrate consolidation（45 eases）,multiple cavities within infiltrate consolidation（40 cases）,nosegmental distribution（23 cases）, bronchi disseminate focus（21 cases）,and pleural fluid（10 cases）. The X-ray and CT appearances of patients dropsical nephritis or SLE included acute hematogenous dissemination pulmonary tuberculosis（15 cases）,vary sized infiltrate consolidation（17 cases）,complicating lymphadenectasis in hilum of lung and mediastinum（4 cases）.The CT findings of pulmonary tuberculosis with AIDS were patch shadow complicated with lymphadenectasis（5 cases）,and acute hematogenous dissemination pulmonary tuberculosis complicated with lymphadenectasis（3 cases）. Conclusion The main radiological findings of patients with pulmonary tuberculosis in immune hypofunction appear larger infiltrate consolidation, multiple cavities within infiltrate consolidation, bronchi disseminate, acute hematogenous dissemination pulmonary tuberculosis, lymphadenectasis in hilum of lung and mediastinum,and infiltrate tuberculosis consolidation in uncommon parts .