艾滋病合并马尔尼菲青霉菌病胸部CT征象分析  

CT features of Penicillium marneffei opportunistic infection in AIDS

作　　者：谢浩锋[1] 郑晓林[1] 黄翔[1] 邹玉坚[1] 钟庆杨[2] 殷思纯[2] XIE Hao-feng ZHENG Xiao-lin HUANG Xiang ZOU Yu-jian ZHONG Qing-yang YIN Si-chun(Department of Radiology, Dongguan People＇s Hospital, Guangdong 323000, Chin)

机构地区：[1]东莞市人民医院放射科,广东东莞523000 [2]东莞市人民医院感染科,广东东莞523000

出　　处：《影像诊断与介入放射学》2017年第2期136-140,共5页Diagnostic Imaging & Interventional Radiology

基　　金：2016年东莞市科技计划立项课题(课题编号:201610515000932)

摘　　要：目的通过对艾滋病合并马尔尼菲青霉菌病的胸部CT征象分析,提高认识和诊断水平。方法回顾性纳入22例经病原学确诊为艾滋病合并胸部马尔尼菲青霉菌病的患者,分析其胸部CT,图像作局部放大和高分辨率重组以仔细观察胸部CT特征,对肺部、胸内淋巴结等各种征象进行分类并探讨胸部CT病变的严重程度与CD_4^+T淋巴细胞计数之间的相关性。结果 22例患者的肺部征象主要表现为肺内多发粟粒和小结节17例(77.3%),可弥漫性分布或少量散发分布,其次为低密度结节或肿块9例(占40.9%),可实性或伴发空洞,另4例患者表现为段以上支气管受侵并狭窄(18.2%),上述患者常合并小叶间隔增厚、支气管血管束增粗及肺气囊等征象。多发淋巴结肿大18例(81.8%),表现明显低密度,增强无强化或轻度环状强化,位于淋巴结多个分区,以7、4R、2R、10R、11R区及左X等区域为主。15例外周血CD_4^+T淋巴细胞<25个/μl患者,肺内病变类型多,累及范围较广泛。但CD_4^+T淋巴细胞计数与病变种类数、胸内淋巴结肿大区域数之间无相关性(r=-0.123和-0.349,P>0.05)。结论艾滋病合并马尔尼菲青霉菌病的胸部CT表现具有一定特点;胸部病变的严重程度与CD_4^+T淋巴细胞计数降低可能有关。认识这些胸部CT征象,结合相关实验室和病原学检查,对诊断具有重要的价值。Objective To analyze the chest CT features of Penicillium marneffei opportunistic infection in patients with acquired immune deficiency syndrome （AIDS）.Methods High-resolution chest CT of 22 patients with AIDS and Penicillium marneffei infection was retrospectively analyzed.The CT appearance of lung lesions and lymphadenopathy was correlated with CD4＋ lymphocyte count.Results CT showed bilateral diffuse or scattered pulmonary micronodules （17/22,77.3%）,low-density lung nodules or masses （9/22,40.9%）,segmental bronchial narrowing （4/22,18.2%） as well as interlobular septal thickening,dilatation of bronchovascular bundles,bronchial wall thickening,and lung air sacs.Hypodense,non-or mildly rim-enhancing lymph node enlargement in the mediastinum and hila （18/22,81.8%）.In 15 patients with CD4＋ lymphocytes count 〈25/μl,the puhnonary lesions were more widespread.However,the CD4＋ lymphocyte count did not correlate significantly （P〉0.05） with the types of lung lesions （r=-0.123） and extent of lymphadenopathy （r=-0.349）.Conclusion Lung lesions and lymphadenopathy are more extensive and severe with lower CD4＋ lymphocyte count in patients with AIDS complicated by Penicilliosis marneffei.

关 键 词：艾滋病 马尔尼菲青霉菌病 体层摄影术 X线计算机 

分 类 号：R512.91[医药卫生—内科学] R816.41[医药卫生—临床医学]