28例AIDS合并肺部疾病病人的支气管镜检查结果分析

Analysis on the bronchoscopy in 28AIDS patients with lung diseases

目的评估支气管镜检查对艾滋病(AIDS)病人合并肺部疾病的应用价值。方法分析28例AIDS合并肺部疾病病人的临床表现、胸部CT、支气管镜下表现、支气管肺泡灌洗液(BALF)检验结果、经支气管肺活检病理结果。结果 28例病人的BALF结果:涂片革兰染色G+球菌阳性8例,G-杆菌阳性3例;涂片查抗酸杆菌阳性1例;涂片查真菌孢子及菌丝全阴性;人类巨细胞病毒脱氧核糖核酸(HCMV DNA)阳性14例;结核分枝杆菌脱氧核糖核酸(TB DNA)阳性5例;细菌培养铜绿假单胞菌4例,肺炎链球菌1例,烟曲霉菌2例,白色念珠菌1例。支气管肺活检组织病理:鳞癌3例,小细胞癌1例,肉芽肿性炎1例。根据支气管镜检查结果分为肺癌组(4例)、肺结核组(10例)、其他病原体感染组(14例)。经Kruskal-wallis检验,3组病人CD4+T淋巴细胞计数之间差异有统计学意义(P=0.016)。结论支气管镜检查可显著提高AIDS病人各种肺部疾病的病因诊断率,而且不受病人免疫功能缺陷的影响,具有较高的应用价值。

Objective To evaluate the value of utility of bronchoscopy in human immunodeficiency virus/acquired immunodeficiency syndrome（HIV/AIDS）patients with lung diseases.Methods Bronchoscopy was conducted to 28 HIV/AIDS patients with lung diseases.The pateints’clinical manifestations,chest CT,the appearance under bronchoscope,the results of bronchoalveolar lavage fluid（BALF）test and transbronchial biopsy were analyzed.Result Of 28 HIV/AIDS patients,8cases（29.63%）were BALF smear Gram staining G＋cocci positive,3cases（11.11%）were G-bacillus positive;1（3.7%）smear acid-fast bacillus positive;both smear fungal spores and hyphae were negative;14cases（63.64%）were human cytomegalovirus deoxyribonucleic acid（HCMV DNA）positive and 5cases（21.74%）were mycobacterium tuberculosis deoxyribonucleic acid（TB DNA）positive.For BALF bacterial culturing,4（26.67%）were pseudomonas aeruginosa,1（6.67%）streptococcus pneumoniae,2cases（13.33%）were aspergillus fumigatus and 1case（6.67%）candida albicans.For transbronchial biopsy pathology,3 were quamous carcinoma,1small cell carcinoma and 1granulomatous inflammation.According to the bronchoscopy results,28HIV/AIDS patients were divided into three groups：lung cancer group（four cases）,tuberculosis group（10cases）and other pathogen infected group（14cases）.CD4＋T lymphocyte count were compared by Kruskal-wallis test,significant differences were found among the three groups（P=0.016）.Conclusions Bronchoscopy can improve the diagnosis of the cause of lung diseases in AIDS patients and will not be affected by immunosuppression of AIDS patients.