严重免疫缺陷时HIV/TB合并感染者胸部CT表现与CD4^+T淋巴细胞计数水平的相关性研究  

Association between CD4^+T cell counts and chest CT scan parameters in severely immunocompromised patients coinfected with human immunodeficiency virus and tuberculosis

作　　者：袁婧[1] 李春华[2] 李奇穗[1] 余庆 吕圣秀 陈耀凯[1] YUAN Jing;LI Chun-hua;LI Qi-sui;YU Qing;LV Sheng-xiu;CHEN Yao-kai(Third Department of Infectious Diseases,Chongqing Public Health Medical Center,Chongqing 400036,China;Department of Radiology,Chongqing Public Health Medical Center,Chongqing 400036,China)

机构地区：[1]重庆市公共卫生医疗救治中心感染三科,重庆400036 [2]重庆市公共卫生医疗救治中心放射科,重庆400036

出　　处：《新发传染病电子杂志》2019年第3期145-148,共4页Electronic Journal of Emerging Infectious Diseases

基　　金：“十三五”国家科技重大专项课题(2018ZX10302104);重庆市卫生计生委医学科研项目(2017MSXM116)

摘　　要：目的分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)与结核(Tuberculosis,TB)合并感染者严重免疫缺陷的胸部CT影像学表现,从不同角度分析CD4^+T淋巴细胞计数与CT影像学参数的相关性。方法分析2017年1月至2017年12月本院HIV/TB合并感染住院患者的临床资料及胸部CT扫描结果,比较不同CD4^+T淋巴细胞计数水平的感染者胸部CT影像学参数是否存在差异,包括病变累及肺叶数、病变性质、病变形态、纵膈淋巴结肿大数、肿大淋巴结最大直径和最小直径等。结果所有118例HIV/TB合并感染者CD4^+T淋巴细胞计数均较低,其中116例<200个/μl。HIV/TB患者肺部病变常累及多个肺叶,且纵膈淋巴结平均肿大个数、肿大淋巴结的最大径均大于单纯TB组(P<0.05);渗出、结节及粟粒状表现在HIV/TB组较单纯TB组常见(P<0.05);对于严重免疫缺陷患者(CD4+T淋巴细胞数<200个/μL),不论CD4^+T淋巴细胞计数高低,其胸部CT影像学参数无明显差异,仅低CD4^+T淋巴细胞计数(<100个/μL)患者的纵膈淋巴结肿大的最大直径大于较高CD4^+T细胞计数组(>100个/μL),差异具有统计学意义(P<0.005)。结论当CD4^+T淋巴细胞计数低于200个/μL时,免疫损伤严重程度并不会导致患者胸部影像学特征出现本质性差异,但免疫损伤极为严重者(CD4^+T淋巴细胞计数水平低于100个/μL)纵膈淋巴肿大更为显著。Objective To investigate whether chest CT scan parameters have any association with CD4^+T cell counts in severely immunocompromised patients coinfected with human immunodeficiency virus(HIV)and tuberculosis(TB).Methods This was a retrospective study and we collected and analyzed the clinical data and chest CT scan results of HIV/TB coinfected patients admitted between January 2017 and December 2017.Results 118 patients coinfected with HIV and TB were included,and 116 patients had CD4+T cell counts less than 200 cells/μl.There are multiple lobar lesions in HIV/TB patients,and the average numbers of mediastinal lymph nodes、the maximum diameter of lymph nodes were larger in patients ofHIV/TB(P<0.05).Exudation,nodules and miliary lesion were more common in patients of HIV/TB(P<0.05).No significant differences ware observed in chest CT of patients with severe immunodeficiency(CD4^+T cells<200/μL),except that the maximum diameter of mediastinal lymph node in patients with CD4^+T cell count less than 100/uL is larger than that in patients with CD4^+T cell count more than 100/μL,(P<0.005).Conclusion There are no significantly noticeable differences in chest CT scan parameters between patients with lower and higher CD4^+T cell counts when their CD4^+T cell counts are less than 200 cells/μl,except that the enlargement of mediastinal and hilar lymph nodes is more recognizable in patient with CD4^+T cell counts less than 100 cells/μl.

关 键 词：人类免疫缺陷病毒 结核病 CD4^+T淋巴细胞计数 胸部CT表现 

分 类 号：R512.91[医药卫生—内科学]