低CD4^+T细胞的HIV感染合并肺结核影像特点分析

Imaging features of pulmonary tuberculosis in low CD4^+T cell count HIV infected patients

目的分析低CD4^+T细胞的HIV感染合并肺结核患者胸部CT表现,探讨低CD4^+T细胞的HIV感染合并肺结核的影像特点。方法选取深圳市第三人民医院2014年1月至2016年12月32例CD4^+T细胞计数小于200个/μl且已确诊感染肺结核的HIV感染者的胸部CT进行回顾性分析,分析患者胸部CT的病变形态、病变部位等。结果 32例低CD4^+T细胞计数HIV感染者胸部影像主要表现为:纵隔或肺门淋巴结结核30例(93.7%)、实变影29例(90.6%)、胸腔积液21例(65.6%)、空洞影17例(53.1%)、弥漫粟粒影14例(43.7%)、纤维灶9例(28.1%)、钙化灶3例(9.3%)。对12例患者在抗结核治疗前进行短时间(15~25天)复查发现部分影像征象较前明显进展,实变影范围较前扩大(11例)、弥漫粟粒影较前增多(12例)、胸腔积液较前增多(8例)、空洞影较前增大或增多(4例)、纵隔或肺门淋巴结增大(3例)。结论低CD4^+T细胞的HIV感染合并肺结核的影像表现多样,常见纵隔或肺门淋巴结结核、实变影、空洞影及弥漫粟粒影,而纤维病灶和钙化灶相对少见,表现为不典型肺结核的影像特点。

Objective The aim of this study is to retrospectively analyze the chest CT manifestations of pulmonary tuberculosis in patients with low CD4+T count of HIV infection,and to investigate the imaging features of pulmonary tuberculosis with low CD4+T count in HIV infected patients.Methods Chest CT of 32 patients who has been diagnosed with HIV infection and pulmonary tuberculosis and with CD4+T cell count less than 200/μl were analyzed.Results 32 cases of low CD4+T cell count of HIV infection of chest imaging features were mainly as follows:cavity shadow in 17 cases,consolidation shadow in 29 cases,diffuse miliary shadow in 14 cases,pleural effusion in 21 cases;3 cases of calcification,9 cases of fibrous lesions and 30 cases of mediastinal or hilum lymph node tuberculosis.Conclusions Low CD4+T cell count of HIV infection in patients with pulmonary tuberculosis showed a variety of imaging features,disseminated pulmonary tuberculosis and lymph node tuberculosis were easily found while calcification and fibrous lesions are rare,presenting imaging feature of atypical pulmonary tuberculosis.