20例艾滋病病人免疫重建中合并结核相关性重建炎性综合征的胸部CT影像特点

Specific features of chest CT image changes related to inflammatory syndrome associated with pulmonary tuberculosis in 20 AIDS patients during their immunological reconstruction

目的探讨艾滋病(AIDS)病人在免疫重建过程中,合并与肺结核相关重建炎性综合征的胸部计算机层析成像(CT)影像特点。方法采用回顾性分析的方法,对20例AIDS病人免疫重建过程中,合并结核相关性重建炎性综合征的胸部CT影像进行分析。结果 20例AIDS免疫重建合并肺结核相关重建炎性综合征病人的胸部CT影像,表现为急性血行播散型肺结核与继发型肺结核,急性血行播散型肺结核9例(45.0%,9/20),继发型肺结核11例(55.0%,11/20)。病灶分布3个肺叶及以上者7例(35.0%,7/20),病灶局限于1～2个肺叶者4例(20.0%,4/20)。病变形态为粟粒影、结节影、肺段与亚段实变影,分别为13例(65.0%,13/20)、9例(45.0%,9/20)、5例(25.0%,5/20),肺空洞3例(15.0%,3/20)。胸部CT影像出现纵隔淋巴结肿大伴液化坏死17例(85.0%,17/20),胸腔积液15例(75%,15/20)。结论 AIDS免疫重建合并肺结核相关重建炎性综合征时,胸部CT影像特点是病变呈弥漫、多肺叶分布,粟粒影、结节影、肺段与亚段实变影为肺部病变主要形态,纵隔淋巴结肿大伴液化坏死、胸腔积液常见。其发生机制与重新激活的异常免疫应答相关。在高效抗反转录病毒治疗同时,积极给予抗结核治疗后,病变吸收明显。

Objective To investigate the specific features of chest CT image changes related to inflammatory syndrome associated with pulmonary tuberculosis in AIDS patients during their immunological reconstruction. Methods The chest CT image change related to inflammatory syndrome associated with pulmonary tuberculosis were analyzed in 20 AIDS patients during their immunological reconstruction. Result All the chest CT images re lated to inflammatory syndrome associated with pulmonary tuberculosis in 20 AIDS patients during their immunological reconstruction indicated that 9 cases were acute hematogenous pulmonary tuberculosis （45.0%, 9/20）, and 11 cases were secondary tuberculosis （55.0%, 11/20）. As indicated by CT images, 7 cases had loci over 3 lung lobes or more （35.0%, 7/20）, and 4 cases had loci in 1 or 2 lobes （20.0%, 4/20）. As to the lesion shape , 13（65.0%, 13/20）, 9 （45.0% ,9/20） and 5 （25.0% ,5/20） eases had miliary and nodular shapes and consolidation of pulmonary segment and sub-segment, respectively. Three cases had pulmonary cavity （15.0 %, 3/20）, 17 cases had mediastinal lymphadenovarix with liquefied necrosis （85.0%, 17/20） and 15 case had pleural effusion （75 %, 15/20）. Conclusion During the immunological reconstruction and inflammatory syndrome associated with pulmonary tuberculosis, the chest CT images indicate a distribution of diffuse and multilobe lesions distribution, miliary and nodular shapes as well as the consolidation of pulmonary segment and sub-segment. In addition, the mediastinal lymphadenovarix and liquefied necrosis are quite common. The mechanism is related to the abnormal immune response during the reactivation. The absorption of the lesion is obvious when anti-tuberculosis therapy is given simultaneously with the highly active antiretroviral therapy.