获得性免疫缺陷综合征患者鸟-胞内分枝杆菌感染的胸部影像学分析

Chest imaging features of acquired immunodeficiency syndrome patients complicated with Mycobacteriumavium-intracellulare complex infection

目的探讨获得性免疫缺陷综合征(AIDS)合并鸟-胞内分枝杆菌(MAC)感染的胸部影像表现及特点,并与AIDS合并肺结核的影像表现进行对比分析研究,以期为临床诊断提供帮助。方法收集经菌种鉴定为MAC的AIDS患者27例入组,将经抗酸菌培养确诊为肺结核的AIDS患者50例作为对照组,两组均行胸部CT检查,影像观察内容包括:肺内病灶部位、形态、大小、边界,纵隔、肺门、两侧腋窝淋巴结情况,腹膜后淋巴结情况,肝脾情况,总结分析两组患者的影像表现,并应用SPSS20.0软件对两组相关数据进行统计对比分析。结果 MAC感染组:27例外周血CD_4^+T淋巴细胞计数<50cells/μl 19例,占70.37%,>200cells/μl 0例;AIDS合并肺结核:50例外周血CD_4^+T淋巴细胞计数<50cells/μl 32例,占64.00%,>200cells/μl 3例,占6.0%,MAC感染组与肺结核组CD_4^+T淋巴细胞计数差异有统计学意义(P<0.05);MAC感染与肺结核两者在肺内病变分布方面差异无统计学意义;胸膜增厚:MAC组的概率为11.11%,肺结核组的概率为32.00%,两者差异有统计学意义(P<0.05);当CD_4^+T淋巴细胞计数<50cells/μl时,MAC组支气管扩张出现的概率为68.42%,肺结核组为34.37%,两者差异有统计学意义(P<0.05)。结论 AIDS合并MAC感染的常见征象与肺结核影像表现相似;支气管扩张在MAC感染中比肺结核常见,胸膜增厚则相反;肺外表现脾内低密度结节病变在肺结核中比MAC感染常见。

OBJECTIVE To explore the chest imaging manifestations and features of acquired immunodeficiency syndrome（AIDS）patients complicated with Mycobacterium avium-intracellulare complex（MAC）infection and compare with the imaging manifestations of the AIDS patients complicated with pulmonary tuberculosis so as to provide guidance for clinical diagnosis.METHODS Totally 27 AIDS patients who were identified as MAC infection through bacterial identification were enrolled in the study,and 50 AIDS patients who were confirmed as pulmonary tuberculosis with culture of acid-fast bacilli were set as the control group.Both groups received the chest CT examination,and the contents of the imaging examination included the pulmonary lesion sites,shape,size,borders,mediastinum,hilar lymph nodes on both sides of the armpit,retroperitoneal lymph nodes,and liver and spleen.The imaging findings were observed and compared between the two groups of patients,and the statistical analysis of the two groups of data was performed with the use of SPSS20.0software.RESULTS Among the 27 AIDS patients with MAC infection,there were 19（70.37%）patients with the peripheral blood CD_4＋T lymphocyte counts less than 50cells/μl and no patient with the counts more than 200cells/μl.Among the 50 AIDS patients complicated with pulmonary tuberculosis,there were 32（64.00%）patients with the peripheral blood CD_4＋T lymphocyte counts less than 50cells/μl and 3（6.0%）patients with the counts more than 200cells/μl;there was significant difference in the CD_4＋T lymphocyte counts between the MAC infection group and the pulmonary tuberculosis group（P〈0.05）.There was no significant difference in the distribution of pulmonary lesions between the patients with MAC infection and the patients with pulmonary tuberculosis.The probability of pleural thickening was11.11%in the MAC infection group,32.00%in the pulmonary tuberculosis,and there was significant difference between the two groups（P〈0.05）.CONCLUSION The common signs of the AIDS patients complicated with MAC infection are similar to the imaging manifestations of the patients with pulmonary tuberculosis.The bronchiectasia is more common in the patients with MAC infection than in the patients with pulmonary tuberculosis,while the pleural thickening is on the contrary.The extrapulmonary manifestations of low-density nodules lesions in spleen are more common in the patients with pulmonary tuberculosis than in the patients with MAC infection.