艾滋病合并肺结核与合并肺孢子虫肺炎的影像学比较研究

Comparing study of AIDS complicated by pulmonary tuberculosis and Pneumocystis carinii pneumonia in Radiological character

目的 分析艾滋病病人合并肺结核（TB）与合并卡氏肺孢子虫肺炎（PCP）的影像学特征差异，探讨其鉴别诊断。方法 回顾性分析32例CD4细胞低200个/μL的艾滋病病人，19例感染肺结核，13例PCP，分别比较病变的影像学特征与病变的分布范围。结果 PCP与TB比较，影像学上毛玻璃密度影、斑片状渗出、大小不等结节两组间差别无显著性（P〉0．05）。两组病变均可能出现病变多于3个肺野（84．62％，63．16％，P〉0．05）。感染TB时，粟粒结节、增殖病变、空洞、肺外感染、胸水，虽然发生率稍高，但两组间差别仍无显著性（P〉0．05）。肺门及纵隔淋巴结肿大时多为TB（P〈0．05），PCP更多出现肺大片实变与肺气囊（P〈0．05）。TB病变多位于上肺尖段或下叶背段（42．11％，7．69％，P〈0．05），病变的发展多由上肺往下肺进行（31．58％，P〈0．05）。患PCP时，病变主要位于下肺（53．85％，15．79％，P〈0．05），其发展主要由下肺往上肺（38．46％，5．26％，P〈0．05），由肺门向外带（30．77％，P〈0．05）。结论 在艾滋病期，当CD4细胞计数〈200个/μL时，感染TB与PcP均可能出现毛玻璃影、大小不等结节影，双肺弥漫性改变。TB更多出现肺门及纵隔淋巴结肿大，病变多在上肺尖段及下叶背段，由上向下蔓延。出现大片实变，肺气囊，病变由下肺向上蔓延，由肺门为中心向外扩展，则诊断为PCP。

Objective To discuss the Radiological character of pulmonary Tuberculosis （TB） and Pneumocystis carinii pneumonia （PCP） in patients with AIDS. Special emphasis is placed on features helpful in differentiating between PCP and TB. Methods A retrospective analysis was carried out the Radiological character of chest in 32 case AIDS. Their CD4^＋ T lymphocytes were lower 200/μl. Infected TB was 19, PCP 13 cases. Compared manifestation of chest X-ray and distributing. Results Comparing between PCP and TB, No significant difference was found in Ground glass opacity, spot shape exudation, abnormity size nodus （P〉0.05）.Although the Infected with TB was generally observed in miliary nodus, proliferate, cavity, extra-pulmonary infected, pleural effusion. But those distinction was no significant as well （P〉0.05）. Pulmonary hilar and/or mediastinal lymphadenopathy may also be observed in these patients with TB （P〈0.05）. The chest X-ray demonstrated Pulmonary diffuse exudation and intrapulmonary air containing space in PCP （P〈0.05）.TB was distributed in upper pulmonary apical segment and Superior segment of Lower field （42.11%,7.69% P〈0.05）. TB spread from upper lobar to lower lobar （31.58%, P〈0.05）. PCP may initially be found in lower pulmonary （53.85%, 15.79%, P〈0.05）. PCP produced typical distribution, from lower segment or lobar to super field （38.46%, 5.26%, P〈0.05）, from hilar to periphery （30.77%, P〈0.05）. Two group patients were usually distributed over 3 pulmonary fields （84.62%, 63.16%, P〉0.05）. Conclusion Those patients with infected TB and PCP in later stage AIDS （CD4^＋ T lymphocytes〈200/μL） may be observed Ground glassopacity, spot shape exudation, abnormity size nodus. The chest radiograph of TB typically reveals Pulmonary hilar and/or mediastinal lymphadenopathy, TB was distributed in upper pulmonary apical segment and Superior segment of Lower field, spread from upper lobar to lower lobar. Pulmonary diffuse exudation, intrapulmonary air containing space, spread from lower lobar to super lobar, from hilar to periphery may be demonstrated as PCP.