超声介入穿刺肺活检在AIDS相关多重肺部感染诊断中的应用

Application of ultrasound-guided percutaneous lung biopsy in the diagnosis of AIDS related multiple microbial pulmonary infections

目的 探讨超声引导经皮穿刺肺活检(ultrasound-guided percutaneous lung biopsy,UGPLB)在AIDS相关多重肺部感染(multiple microbial pulmonary infections,MMPI)诊断中的应用价值。方法 选取2012年8月至2023年8月南宁市第四人民医院临床初诊疑为MMPI的257例AIDS患者的周边型肺病灶实施UGPLB,获取的肺病变标本作病理组织学检查及病原体检测。结果 UGPLB成功率为98.05%(252/257);UGPLB成功的252例患者中最终确诊为MMPI 203例(80.56%),其中结核分枝杆菌+真菌混合感染95例(37.70%),结核分枝杆菌+非特异细菌混合感染77例(30.56%),肺炎克雷伯菌+真菌混合感染16例(6.35%),结核分枝杆菌+马红球菌+真菌混合感染15例(5.95%);单一病原体肺部感染49例(19.44%)。穿刺术后并发症7例(2.72%),均症状轻微。结论 对临床疑诊为MMPI、超声显示周边型肺病灶的患者实施UGPLB采集肺病变标本,成功率高,并发症发生率低,有助于提升对MMPI的诊断及鉴别诊断。

Objective To explore the application value of ultrasound-guided percutaneous lung biopsy(UGPLB) in the diagnosis of AIDS relate multiple microbial pulmonary infections(MMPI).Method The peripheral lung lesions of 257 AIDS patients with suspected MMPI in the Fourth People's Hospital of Nanning were selected to implement UGPLB from August 2012 to August 2023,and the obtained lung lesion samples were subjected to histopathological examination and pathogen detection.Result The success rate of UGPLB was 98.05%(252/257),203 cases(80.56%) were finally diagnosed as MMPI,including 95 cases (37.70%) of Mycobacterium tuberculosis + fungus mixed infection,77 cases (30.56%) of Mycobacterium tuberculosis + non-specific bacteria mixed infection,16 cases (6.35%) of Klebsiella pneumoniae+fungus mixed infection,and 15 cases (5.95%) of Mycobacterium tuberculosis + Rhodococcus equi + fungus mixed infection;49 cases (19.44%) had single pathogen pulmonary infection.There were 7 cases (2.72%) of complications after puncture,and all of them had mild symptoms.Conclusion The implementation of UGPLB to collect lung lesion specimens for patients with clinically suspected MMPI and peripheral lung lesions revealed by ultrasound has high success rate and low complication rate,helps to improve the diagnosis and differential diagnosis of MMPI.