艾滋病合并肺结核的影像学研究

Study on imaging findings of AIDS with pulmonary tuberculosis

目的对比艾滋病(AIDS)合并肺结核与单纯肺结核病人的影像学差异,探讨AIDS合并肺结核的影像学特征。方法对45例AIDS合并肺结核病人进行影像学检查,其中胸部平片及CT检查7例,单纯CT检查38例,其中8例加做高分辨率CT(HRCT)扫描,4例加做增强扫描。单纯肺结核50例病人均有CT扫描。对合并肿块或纵隔可疑淋巴结结核病人行增强扫描。扫描结果根据发病部位、范围及病变性质进行对比分析。结果病变部位及范围对比:病变累及双肺、病变累及两叶和两叶以上、病变仅累及肺基底部或(和)前部(舌叶、中叶、上叶前段)组间的出现率之间的差异具有统计学意义(P<0.05)。病变性质特点对比:斑片状或大片状实变阴影、多发结节影、胸内淋巴结结核、胸腔积液出现率组间的差异具有统计学意义(P<0.05)。大片实变影内多发空洞出现率两者差异有统计学意义(χ2=4.222,P=0.040)。两组患者年龄及CD4T细胞数检测结果对比:年龄比较差异无统计学意义(t=1.797,P=0.076);45例AIDS合并肺结核患者CD4T细胞中位数为41/mm3,30例单纯肺结核患者CD4T细胞中位数为244/mm3,二者比较差异有统计学意义(u=107.000,P<0.001)。结论AIDS合并肺结核的胸部X线影像学表现由于CD4T细胞数减少而不典型。AIDS病人胸部呈多肺叶浸润,不典型部位(肺基底部或前部)亦常被侵犯,多发斑片或大片状实变阴影、多发结节性病变、纵隔淋巴结肿大、大片实变影内多发小空洞发生率明显增高,且常常是多种不典型征象并存。

Objective To observe the imaging features of pulmonary tuberculosis with AIDS and the difference from pulmonary tuberculosis without AIDS.Methods Among 45 AIDS patients with pulmonary tuberculosis,7 cases underwent CT scan and chest plain films,38 cases underwent CT scan（8 cases with HRCT scan and 4 cases with contrast-enhanced scan additionally）.Fifty non-AIDS patients with pulmonary tuberculosis underwent CT scan.The contrast-enhanced scan was performed when the mass or mediastinal adenopathy was defined.A retrospective contrast analysis was carried out according to the location and character of imaging findings.Results ＂The location and range of lesions＂：distributed in two lungs,more than two lobes,only in the bases and（or）the anterior segment of the lung had significant difference between two groups（P〈0.05）.＂Characteristics＂：patchy and larger confuent consolidation,multiple nodular opacities,pleural effusion and large confuent consolidation with multiple small cavities had significant difference between two groups.However,the occurrence of extra-chest lesions had no significant difference between two groups（P〉0.05）.No significant difference was found in ages between two groups（P〉0.05）.The number of CD4 T lymphocytes had significant difference between the groups（P〈0.001）.Conclusion The imaging findings were closely associated with CD4 T lymphocyte count in AIDS with pulmonary tuberculosis.Image features of AIDS patients with pulmonary tuberculosis include infiltrating multi-lobes and atypical location.Pulmonary tuberculosis in AIDS often showed many atypical faces concomitance.