HIV/AIDS相关性卡氏肺囊虫肺炎的临床特征和影像诊断  

Clinical Characteristics and Imaging Diagnosis of Pneumocystis carinii Pneumonia in HIV/AIDS

作　　者：李跃明[1] 杨凤娥[2] 倪希和[1] 

机构地区：[1]福建医科大学附属第一医院,福建福州350005 [2]福建医科大学附属协和医院,福建福州350001

出　　处：《中华医院感染学杂志》2005年第12期1376-1379,共4页Chinese Journal of Nosocomiology

基　　金：福建省卫生厅青年科学研究基金资助(02A074)

摘　　要：目的探讨HIV/AIDS相关性卡氏肺囊虫肺炎的临床特征和影像学征象。方法收集在援博茨瓦纳玛丽娜公主医院临床及病理证实的卡氏肺囊虫肺炎132例,血液HIV抗体检查均为阳性,对其临床特点、病理机制和影像征象进行综合分析。结果卡氏肺囊虫肺炎以干咳、呼吸困难和低热为典型症状而体征不明显,CD4计数通常<200/μl;典型的影像学表现为两侧肺门到肺周围弥漫对称性的渗出性病变,分布于肺门周围,呈毛玻璃改变,病灶由肺门向周围肺野发展且呈明显的融合趋势。结论卡氏肺囊虫肺炎是HIV/AIDS常见的肺部机会性感染,典型的胸部影像学表现和明显的临床症状而体征轻微者,排除其他原因导致的免疫缺乏性疾病外,经血液检查证实HIV抗体阳性者应积极治疗,尽快获得病理学证据,高分辨率胸部CT扫描显示肺内浸润和肺气囊等病变明显强于X线平片。OBJECTIVE To study the clinical characteristics and imaging findings of Pneumocystis carinii pneumonia（PCP） in patients with HIV/AIDS. METHODS Totally 132 PCP cases with HIV antibody positive were evaluated together with clinical symptoms, pathological mechanism and imaging appearances, which were microscopically confirmed by examination of induced sputum or bronchoalveolar lavage fluid, even autopsy. RESULTS Common clinical symptoms of PCP included nonproductive cough, dyspnea, chest pain, and fever, while physical signs were very mild. CD4 account usually lowered than 200/μl. Typical imaging findings of PCP were bilateral diffuse ground-grass opacities distributing in perihilar regions and presenting as radiate shadows from hila to lung fields. Unusual appearances included lobar consolidation, hilar adenopathy, cystic lesions, pleural effusion and atelectasis, etc. CONCLUSIONS P. carinii pneumonia is a common opportunistic infection in patients with HIV/AIDS. Timely treatment is recommended in patients with typical imaging findings, clinical manifestations and positive HIV antibody when other immunodeficient diseases were ruled out. Microscopic evidence should be further attained. High resolution computed tomograph （HRCT） of chest can reveal lung infiltration and cystic cavities much better than plain chest X-ray.

关 键 词：获得性免疫缺陷综合征 卡氏肺囊虫肺炎 影像诊断 临床特征 

分 类 号：R512.91[医药卫生—内科学]