艾滋病并发纵隔淋巴结结核的CT表现及临床特征

The CT manifestations and clinical features in AIDS patients with mediastinal lymph node tuberculosis

目的探讨获得性免疫缺陷综合征（简称“艾滋病”）并发纵隔淋巴结结核的CT表现及临床特征，以提高对其诊断的水平。方法回顾性分析2013年7月至2016年1月北京地坛医院经病理证实或临床确诊的艾滋病并发纵隔淋巴结结核患者132例（并发组）的CT表现及临床特点，并与同时期北京地坛医院确诊的132例无免疫损伤的纵隔淋巴结结核患者（对照组）进行比较，对比分析两组患者的临床及CT表现特征。结果并发组痰涂片抗酸染色阳性率（10．6％，14／132）明显低于对照组（47．0％，62／132），差异有统计学意义（X^2=42．57，P〈0．01）；并发组CD4^＋T淋巴细胞计数为196×10^6（10^6～307×10^6），明显低于对照组的786×10^6／L（435×10^5～977×10^6／L），差异有统计学意义（Z=55．75，P〈0．01）。并发组并发肺结核较常见（69．7%，92／132）；并发血行播散性肺结核、胸腔积液、心包积液、腹腔淋巴结结核及肝脾结核的比率分别为24．2％（32／132）、30．3％（40／132）、21．2％（28／132）、13．6％（18／132）、12．1％（16／132），均明显高于对照组[分别为8．3％（11／132）、15．9％（21／132）、8．3Ko（11／132）、6．1％（8／132）、3．8％（5／132）]，差异均有统计学意义（X^2值分别为12．25、9．90、8．70、4．27、6．26，P值分别为G0．01、G0．01、G0．01、0．039、0．012）。并发组累及3组以上淋巴结、淋巴结融合、淋巴结直径≥2．0cm及不均匀强化的发生率分别为80．3％（106／132）、72．0％（95／132）、65．2％（86／132）、84．8%（112／132），均明显高于对照组[分别为42．4％（56／132）、34．8％（46／132）、32,．6％（43／132）、40．9％（54／132）]，差异均有统计学意义（y。值分别为39．94、36．55、28．03、54．59，P值均Go．01）。并发组淋巴结均匀强化、无强化及淋巴结钙化的比率分别为9．1％（12／132）、6．1％（8／132）、6．1％（8／132），均明显低于对照组[分别为36．4％（48／132）、22．7％（30／]32）、19．7％（26／132）]，差异均有统计学意义（X^2值分别为27．95、14．87、10．94，P值分别为GO．01、0．016、〈0．01）。结论艾滋病并发纵隔淋巴结结核以不均匀强化为主，病变多累及3组及以上淋巴结，较少出现钙化，痰涂片抗酸染色阳性率较低，CD4^＋T淋巴细胞计数较低，以上特点有助于提示艾滋病并发纵隔淋巴结结核的诊断。

Objective To investigate the CT manifestations and clinical features in patients with acquired immunodeficiency syndrome （AIDS） complicated with mediastinal lymph node tuberculosis in order to improve diagnostic ability. Methods We analyzed retrospectively the data of CT manifestations and clinical features from 132 cases with AIDS complicated with mediastinal lymph node tuberculosis confirmed by pathology or clinical （as complicated group） and 132 cases with mediastinal lymph node tuberculosis （as control group） in Beijing Ditan Hospital during July 2013 to January 2016. The CT manifestations and clinical features were compared in two groups. Results The rate of acid fast bacilli （10.6%, 14/132） in the complicated group was lower than that （47.0%, 62/132） in control group with significant difference statistically （Xe value 42.57 and P〈0.01）. The CD4 lymphocyte count （196× 10^6（ 10^6 -307 × 10^6 ）） in the complicated group was significantly lower than that （786 × 10^6/L （435× 10^6 - 977 × 10^6/L） ） in the control group （Z= 55.75, P〈0.01 ）. Pulmonary tuberculosis was common in patients with AIDS （69.7%, 92/132）. The rate of hematogenous disseminated pulmonary tuberculosis, pleural effusion, pericardial effusion, tuberculosis of abdominal lumph nodes and tuberculosis of spleen complicated in the complicated group （24.2% （32/132）, 30.3% （40/132）, 21.2%0 （28/132）, 13.6% （18/132） and 12.1% （16/132）） were higher than those （8.3% （11/132）, 15.9% （21/132）,8.3% （11/132）,6.1% （8/132）,3.8% （5/132）） in the control group with significant difference statistically （Z2 value were 12.25, 9.90, 8.70, 4.27 and 6.26, P value were less than 0.01, 0. 01, 0.01 and equal to 0. 039 and 0. 012）. The rate of three or more group lymph nodes involved, lymph node fusion, lymph node with diameter more than 2.0 cm and heterogeneous enhancement of lymph node （80.30% （106/132）, 72.0% （95/132）, 65.2% （86/132） and 84.8% （112/132）） in the complicated group were higher than those （42.4%（56/132） ,34.8% （46/132） ,32.6% （43/132） and 40.9% （54/132）） in the control group with significant difference statistically （X^2 value were 39.94,36.55,28.03 and 54.59, P〈0.01 for all）. The rate of homogeneous enhancement, non-enhancement and calcification of lymph node （9.1% （12/132）, 6.1% （8/132）and 6.1 % （8/132）） in the complicated group were lower than those （36.4% （48/132）,22.7% （30/132） and 19.7 % （26/132） ） in the control group with significant difference statistically （X^2 value were 27.95, 14.87 and 10.94,P〈0.01, 0. 016 and d0.01）. Conchtsion The characteristics of more heterogeneous enhancement, three group lymph node involved, less calcification, less sputum smear acid fast bacilli positive and low CD4 lymphocyte count in AIDS patients complicated with mediastinal lymph node tuberculosis were helpful to diagnose this disease.