艾滋病合并肺结核的影像学特征及其与CD_4^+T淋巴细胞的相关性  

Radiological features of AIDS complicated by pulmonary tuberculosis and the association with CD_4^+T lymphocytes

作　　者：陆普选[1] 余卫业[2] 朱文科[1] 刘艳[3] 刘锦清[1] 

机构地区：[1]深圳市东湖医院放射科,518020 [2]深圳市东湖医院肺科,518020 [3]深圳市东湖医院传染科,518020

出　　处：《中华结核和呼吸杂志》2005年第1期13-16,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中国疾病预防控制中心结核病预防控制中心基金资助项目 (2 0 0 3 3 3 )

摘　　要：目的　探讨艾滋病合并肺结核病的影像学特征及其与CD+ 4 T淋巴细胞的相关性。方法　回顾性对照分析 2 6例艾滋病晚期合并肺结核患者与 6 0例单纯性肺结核患者的胸部X线表现、CD+ 4 T淋巴细胞的检测结果。结果　 (1)胸片结果显示 :艾滋病合并肺结核患者较单纯性肺结核患者出现较多淡片状模糊阴影 (5 3 8%与 8 3% ;P <0 0 1)、粟粒结节影 (2 3 1%与 5 0 % ;P <0 0 5 )、胸内淋巴结肿大 (34 6 %与 8 3% ;P <0 0 1)及肺外结核 (2 3 1%与 3 3% ;P <0 0 5 ) ,较少表现为上肺野或肺尖部病变 (2 3 1%与 76 7% ;P <0 0 1)、实变或密度不均匀增高影 (11 5 %与71 7% ;P <0 0 1)、合并空洞影 (7 7%与 30 0 % ;P <0 0 5 ) ;二者胸腔积液差异无统计学意义(11 5 %与 2 0 0 % ;P >0 0 5 )。 (2 )CD+ 4 T淋巴细胞检测结果显示 :2 6例艾滋病合并肺结核患者与 31例单纯性肺结核患者的CD+ 4 T淋巴细胞相对数分别为 (5 0± 6 4 ) %与 (6 5 3± 1 5 ) % ,两者比较差异有统计学意义 (P <0 0 1) ;2 6例艾滋病合并肺结核患者中 ,CD+ 4 T淋巴细胞计数 <5 0个 / μl的 15例患者均为不典型肺结核 ,CD+ 4 T淋巴细胞计数为 5 0～ 10 0个 / μl的 4例中 ,有 3例为不典型肺结核 ,而 4例CD+ 4 T淋巴细胞计数为 >10 0～Objective To explore the imaging features in cases with AIDS complicated by pulmonary tuberculosis and the association with CD+ 4 T lymphocytes. Methods A retrospective analysis was carried out of the manifestations of chest X-rays in patients with late stage AIDS complicate by pulmonary tuberculosis (n=26 cases) and patients with pulmonary tuberculosis only (n=60 cases). The results of measurements of CD+ 4T lymphocytes were compared. Results (1) The chest X-ray features in patients with AIDS complicated by pulmonary tuberculosis showed more patchy and blurring shadows (53.8% vs 8.3%; P<0.01), more military changes (23.1% vs 5.0%; P<0.05), more enlarged intrathoracic lymph nodes (34.6% vs 8.3%; P<0.01) as well as more extra-pulmonary tuberculous processes (23.1% vs 3.3%; P<0.05) as compared to patients with pulmonary tuberculosis alone. Fewer upper lung or apical lesions (23.1% vs 76.7%; P<0.01), as well as less consolidation(11.5% vs 71.7%; P<0.01) and cavity formation (7.7% vs 30.0%; P<0.05) were found in AIDS patients. No significant difference was found in the occurrence of hydrothorax (11.5% vs 20.0%; P>0.05). (2) The relative numbers of CD+ 4 T lymphocytes in patients with AIDS complicated by pulmonary tuberculosis and in patients with pulmonary tuberculosis alone were (5.0±6.4)% and (65.3±1.5)% respectively. Atypical manifestations of tuberculosis were found in 15 out of the 26 cases of AIDS patients showing a CD+ 4 T lymphocytic count <50/μl, in 3 of the 4 cases with the count between 50/μl-100/μl , while in cases with CD+ 4T lymphocytic count between 100/μl -200/μl (n=4) and >200/μl (n=2), numbers of atypical tuberculosis were 2 and 0 respectively. Conclusions The chest X-ray changes of tuberculosis in cases with late stage AIDS were mostly of the atypical pattern, and were related to a significant decrease in CD+ 4T lymphocyte count.

关 键 词：艾滋病 CD4^+T淋巴细胞 不典型肺结核 患者 影像学特征 单纯性 相关性 合并 结论 意义 

分 类 号：R512.91[医药卫生—内科学] R521[医药卫生—临床医学]