艾滋病合并马尔尼菲青霉菌感染的胸部影像学诊断价值  

The Value of Pulmonary Manifestations in AIDS with Disseminated Penicillium Marneffei Infection

作　　者：陈碧华[1] 刘晋新[1] 李子平[2] 江松峰[1] 张烈光[1] 黄德扬[1] 

机构地区：[1]广州市第八人民医院放射科,510060 [2]中山大学附属第一医院影像中心,广州

出　　处：《临床放射学杂志》2009年第2期180-184,共5页Journal of Clinical Radiology

基　　金：广州市科技攻关计划项目(编号:2006Z3-E0431)

摘　　要：目的探讨艾滋病(AIDS)合并马尔尼菲青霉菌(PM)感染的患者胸部影像学表现及其与临床治疗后转归的关系。资料与方法回顾性分析45例AIDS合并PM感染患者的胸部X线和CT表现,并与病灶的吸收时间、体内PM的转阴时间及患者预后情况进行对照分析。结果(1)AIDS合并PM感染的胸部影像学表现复杂多样:①斑片或大片状渗出病变为主型13例;②结节病变为主型14例;③双肺弥漫粟粒病变为主型4例;④肿块病变为主型4例;⑤双肺肺气囊为主型2例;⑥双肺弥漫磨玻璃样改变为主型3例;⑦双肺弥漫网织状纹理增粗并淋巴结增大2例,仅见纵隔淋巴结增大2例,仅见胸腔少量积液1例。(2)影像学表现与转归:①患者体内PM转阴时间早于胸部病变吸收时间;②粟粒病变为主型患者体内PM转阴的时间长于渗出病变、肿块病变为主型者;③肿块病变为主型患者病变吸收时间长于渗出病变、结节病变及弥漫粟粒病变为主型者;④双肺弥漫磨玻璃样改变和网织状纹理增粗并淋巴结增大患者死亡率最高,其次为肺部结节型患者,再次为渗出病变为主型患者。上述差异在统计学上有显著性意义(P<0.05)。结论AIDS合并PM感染的胸部影像学表现多样,X线平片和CT检查能反映AIDS合并PM感染的病变转归情况;根据不同的影像学表现选择复查时间,有利于指导临床治疗。Objective To analyze the relationship between the pulmonary manifestations of AIDS complicated with disseminated Penicillium Marnefei infection and the prognosis after treatment. Materials and Methods Radiographic findings in 45 cases of AIDS complicated with disseminated Penicillium Marnefei infection were retrospectively analyzed. Based on the consistent treatment, the curative courses of the pulmonary lesions, the courses of PM turning to negative, and the prognosis after treatment comparing with the pulmonary manifestations were analyzed. Results （ 1 ） The pulmonary manifestations of AIDS complicated with disseminated Penicillium Marnefei were complicated. The main imaging manifestations included： （1）prominently patchy exudation （ 13 cases）. （2）nodular patterns （ 14 cases）. （3）miliary lesions in double lungs （4 cases ）. （4）masses （4 cases）. （5）air containing cystic pattern （2 cases）. （6）diffuse ground-glass opacity （3 cases）. （7）others ： diffuse reticular pattern with lymphadenopathy（2 cases）, enlarged mediastinal lymph nodes（2 cases） , pleural effusion（ 1 case）. （2）Pulmonary manifestations and the follow-up after treatment： （1） The curative courses of the pulmonary lesions were longer than the courses of PM turning to negative. （2）In the courses of PM turning to negative, patients with miliary lesions were slower than patients with patchy exudation and mass. （3）The curative courses of mass was longer than patchy exudation, nodular patterns and miliary lesions. （4）The highest mortality in AIDS complicated with disseminated Penieillium Marnefei was the patients with pulmonary diffuse ground-glass opacity and diffuse reticular pattern with lymphadenopathy. Higher mortality was the patients with pulmonary nodular patterns, and then patients with pulmonary patchy exudation. The above difference were significant in statistics（P 〈 0.05 ）. Conclusion The CT and plane film are useful in showing the different chest lesi

关 键 词：艾滋病 马尔尼菲青霉菌 体层摄影术 X线计算机 

分 类 号：R512.91[医药卫生—内科学] R519[医药卫生—临床医学]