艾滋病肺部真菌感染患者CT不同影像学表现时免疫功能变化研究

Change of immune function of AIDS patients with pulmonary fungal infections when having different CT imaging findings

目的探讨艾滋病(AIDS)肺部真菌感染患者肺部CT不同影像学表现时免疫功能变化,为艾滋病的临床诊断及治疗提供参考。方法收集2010年1月-2016年3月医院诊治42例艾滋病肺部真菌感染患者临床资料,分析CT检查、痰真菌培养、CD4+检测结果。结果感染真菌主要为新型隐球菌、白色念珠菌、霉菌等,感染构成比分别为30.95%、23.81%、19.05%;感染部位累及右肺下叶、左肺下叶、右肺上叶等所占构成比分别为80.95%、76.19%、61.90%,CT影像学主要表现为大片实变或斑块、结节影等所占构成比分别为83.33%、73.81%,病变范围多发或广泛分布者占85.71%;不同肺部感染部位及影像学特征表现患者CD_4^+水平比较差异无统计学意义,感染病变范围为多发或广泛分布者CD_4^+水平明显低于单发或局限性分布者,比较差异有统计学意义(P<0.05)。结论艾滋病肺部真菌感染患者感染真菌类型分布多样,CT影像学主要表现为大片实变或斑块为主的多样性,患者肺部病变范围受累广泛者免疫功能更为低下。

OBJECTIVE To explore the change of immune function of AIDS patients with pulmonary fungal infec- tions when having different CT imaging findings so as to provide guidance for clinical diagnosis and treatment of AIDS. METHODS The clinical data were collected from 42 AIDS patients with pulmonary fungal infections Who were treated in hospitals from Jan 2010 to Mar 2016. The CT examination, sputum culture, and detection of CD4 ＋ were performed. RESULTS Cryptococcus neoformans, Candida albicans, and mold were dominant among the fungi causing the infections, accounting for 30.95%, 23.81~, and 19.05%, respectively. The constituent ratios of the infection sites involving the right lower lobe, left lower lobe, and right upper lobe were 80.95~, 76.19%, and 61.90% ,respectively. The constituent ratios of the large consolidation or plaque and nodular shad- ows which were the major CT findings were 83.33% and 73.81% ,respectively. The CD4^＋ level of the patients with multiple or wide distribution of extent of lesions was significantly lower than that of the patients with single or restricted distribution of extent （P〈0.05）. CONCLUSION The species of fungi causing the pulmonary fungal infections in the AIDS patients are diversified. The large consolidation or plaque is the predominant CT imaging finding. The immune function is even low in the patients with extensive pulmonary lesions involving.