艾滋病合并细菌性肺炎的临床影像诊断与鉴别诊断

Clinical imaging diagnosis and differential diagnosis of AIDS complicated with bacterial pneumonia

HIV感染/AIDS患者约50%伴有肺部并发症,包括感染性和非感染性疾病。感染性疾病以耶氏肺孢子菌肺炎、肺结核和细菌性肺炎最多见。目前对AIDS相关耶氏肺孢子菌肺炎和肺结核的相关研究较多,临床影像学也具有一些特征性影像表现为确诊提供一定依据。AIDS相关细菌性肺炎可发生在AIDS自然病程的任一时期,主要的致病菌有肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌及鲍曼不动杆菌等。AIDS相关细菌性肺炎影像学表现为肺内一段、一叶或多叶内有大小不等的浸润性病灶,呈弥漫性或局灶性网状影、结节影、斑片状实变阴影,偶尔可见空洞影或胸腔积液。临床上AIDS相关细菌性肺炎主要应与PJP及PTB进行鉴别。综合患者病史及临床影像特点等可作出临床诊断,通过痰液、支气管肺泡灌洗液的涂片和培养及经皮肺穿刺活检等病原体检查可明确肺炎的病因。

About 50%of HIV/AIDS patients have pulmonary complications,including infectious and non-infectious diseases.At present,there are many studies on AIDS-associated pneumocystis jirovecii pneumonia and pulmonary tuberculosis.Consequently characteristic imaging manifestations can help diagnose them.AIDS-associated bacterial pneumonia can occur at any stage of AIDS.Pathogenic bacteria include Klebsiella,Pseudomonas aeruginosa,Staphylococcus aureus and Acinetobacter baumannii and so on.The imaging features of AIDS-related bacterial pneumonia were invasive lesions of varying sizes in one segment,one lobe or multiple lobes of the lung,with diffuse or focal reticular shadows,nodular shadows,patchy consolidation shadows,but rarely occasional cavity shadows or pleural effusion.AIDS-associated bacterial pneumonia should be distinguished from AIDS-associated pneumocystis jirovecii pneumonia and pulmonary tuberculosis.Clinical diagnosis can be made based on the patient's medical history and clinical imaging characteristics and determined by sputum,bronchoalveolar lavage fluid smear,culture and percutaneous lung biopsy.