AIDS合并结核与非结核分枝杆菌肺病CT影像表现

CT findings of lung disease due to Mycobacterium tuberculosis and non-tuberculous mycobacteria in AIDS patients

目的探讨AIDS合并结核分枝杆菌(Mycobacterium tuberculosis,MTB)和非结核分枝杆菌(non-tuberculous mycobacteria,NTM)肺病CT影像表现的异同。方法回顾性分析32例AIDS合并MTB肺病和13例AIDS合并NTM肺病患者的CT影像资料。结果 2组病变均累及多个肺叶,多种病变同时存在,表现为磨玻璃样或斑片状渗出、大片状实变、沿支气管播散树芽征等;纵隔和/或肺门淋巴结肿大多见;空洞少见;AIDS合并MTB组弥漫粟粒性病变、胸腔积液和/或胸膜增厚比例高于AIDS合并NTM组(P<0.05),结节病灶比例低于AIDS合并NTM组(P<0.05)。结论 AIDS合并MTB和NTM肺病CT均可表现为多肺段分布,多种病变共存,常伴纵隔或肺门淋巴结肿大;如出现两肺弥漫粟粒结节、胸膜增厚或胸腔积液,多提示AIDS合并MTB肺病,而结节病灶多提示AIDS合并NTM肺病。

Objective To compare the CT demonstrations of pulmonary infection due to Mycobacterium tuberculosis（MTB） and non-tuberculous mycobacteria（NTM） in AIDS patients.Methods The CT demonstrations of 32 cases of AIDS complicated with lung disease due to MTB and 13 cases of AIDS complicated with lung disease due to NTM were retrospectively analyzed,and the differences of CT findings were compared between two groups.Results The CT findings in both groups showed that multiple lobes were involved and multiple lesions occurred simultaneously including ground glass appearance,patchy infiltrations,consolidation and ＂tree-in-bud＂ sign.Enlarged hilar and mediastinal lymph nodes were common and cavitation was rare.The percentages of miliary infiltrate,pleural effusion and pleural thickening were higher in MTB group than those in NTM group,and the percentage of nodules was lower in MTB group than that in NTM group（P0.05）.Conclusion The dominant similar CT appearances between MTB and NTM pulmonary infections are lesions distributing in multiple lobes,multiple patterns of lesions coexist,and enlarged hilar and mediastinal lymph nodes are commonly found.But the phenomen on of miliary pulmonary pattern,pleural effusion and pleural thickening indicats of MTB in AIDS patients.On the contrary,nodules will help to diagnose NTM in AIDS patients.