艾滋病合并肺结核CT与病理对照分析

Lung tuberculosis in AIDS patients:CT and pathologic findings

目的:探讨艾滋病合并肺结核的CT影像表现与病理改变及其临床意义。方法:回顾性分析经确诊的13例艾滋病合并肺结核患者的CT影像表现及穿刺活检病理相关资料。13例患者CD4T淋巴细胞计数均小于200/μl。结果:13例肺结核中,CT多表现为结节、肿块影及片状实变影,合并纵隔淋巴结肿大及胸膜炎。病理组织抗酸杆菌染色阳性9例。干酪样坏死及炎性细胞浸润5例,淋巴细胞、纤维组织增生或类上皮细胞浸润5例,肺组织坏死并炎性细胞浸润3例。所有患者的病理组织中均未见到典型结核结节及朗罕氏巨噬细胞。结论:艾滋病合并肺结核主要表现为结节、肿块或片状实变影,合并胸膜炎或纵膈淋巴结肿大。其病理改变主要为炎性肉芽肿和/或合并干酪坏死,缺乏典型结核结节及郎罕氏巨噬细胞,诊断还应结合抗酸杆菌染色。

Objective：To investigate the manifestations of CT,pathology findings and clinical value in AIDS complicated with tuberculous chest infection.Methods：The CT images and biopsy pathologic materials of 13 AIDS patients with lung tuberculosis were analyzed retrospectively.There were 10 males and 3 females（median age 31 years,rang 16~50 years）.The count of CD4 T lymphocytes in all patients was less than 200/μl.Results：Pulmonary nodules,masses and patchy or larger confluent consolidation as well as pleural inflammation or enlarged mediastinal lymph were the most common CT finding in these patients.9 cases presented the acid-fast tubercle bacillus positive stain.All biopsy pathologic histological changes included caseating necrosis and inflammatory reaction（5 cases）,fibroblasts,lymphocytes,or epithelioid cells（5 cases）,lung tissues necrosis and inflammatory reaction（3 cases）,all of patients were lack of granuloma prototype and Langerhans giant cells.Conclusion：CT imaging manifestations in AIDS patients complicated with pulmonary tuberculosis presented nodules,masses and patchy or larger confluent consolidation as well as pleural inflammation or enlarged mediastinal lymph nodes.Because all biopsy pathologic histology changes included inflammation granuloma and/or caseating necrosis,and being lack of granuloma prototype and Langerhans giant cells,the diagnosis should be combined with the acidfast tubercle bacillus positive stain.