艾滋病并发血行播散性肺结核的临床及CT表现分析

Analysis of clinical and CT manifestations of AIDS with concurrent hematogenous disseminated pulmonary tuberculosis

目的分析艾滋病并发血行播散性肺结核的临床及CT表现特点。方法采用回顾性分析,选取2014年1月至2017年12月经本院确诊的83例艾滋病并发血行播散性肺结核患者为研究组,同期94例艾滋病病毒阴性血行播散性肺结核患者为对照组。分析其临床症状、实验室检查及CT表现特点。结果研究组痰菌阳性、结核菌素试验阳性、发热、咳嗽、乏力、盗汗的发生率低于对照组(P均<0.05);CD4^+T淋巴细胞<200个/μL、纳差、体重下降、合并其他感染的发生率高于对照组(P<0.05)。研究组粟粒结节的大小、密度及分布表现为均匀一致者低于对照组(P均<0.05);斑片影、磨玻璃影、小叶间隔增厚、胸腔积液、心包积液、淋巴结肿大及肺外结核的发生率高于对照组(P均<0.05)。结论艾滋病并发血行播散性肺结核临床表现不典型,粟粒结节多呈"三不均匀"分布,常伴纵隔淋巴结肿大及胸腔积液。

Objective To analyze the clinical and CT manifestations of AIDS with concurrent hematogenous disseminated pulmonary tuberculosis.Methods Retrospectively analysis was used in the paper.A total of 82 patients diagnosed as AIDS with concurrent hematogenous disseminated pulmonary tuberculosis in our hospital from January2014 to December 2017 were enrolled as the study group,while a total of 94 patients diagnosed as HIV-negative hematogenous disseminated pulmonary tuberculosis during the same period were regarded as the control group.The clinical symptoms,lab tests and CT manifestations were analyzed in the two groups.Results The incidence of positive sputum bacterium,positive PPD,fever,cough,fatigue and night sweats were lower in the study group than in the control group(P<0.05),while the occurrence of CD4^+<200,poor appetite,weight loss and other combined infection of the study group were higher than those of the control group(P<0.05).The rates of patients with homogeneous sizes,densities and distributions of miliary nodules in the study group were lower than those in the control group(P<0.05).The occurrence of patchy shadow,ground glass opacity,interlobular septal thickening,pleural effusion,pericardial effusion,enlargement of lymph node,and extra pulmonary tuberculosis were higher in the study group than in the control group(P<0.05).Conclusion The clinical manifestations of AIDS complicated with hematogenous disseminated tuberculosis are not typical.The miliary nodules are mostly "three uneven" distribution,often accompanied by mediastinal lymph node enlargement and pleural effusion.