HIV感染者继发耶氏肺孢子菌肺炎的CT表现分析  

Analysis of CT Features of HIV Patients with PJP

作　　者：郑雨婷 韩小雨 樊艳青[1] 贾溪 刘童 汤泽辉 李玉敏 史河水[1] ZHENG Yuting;HAN Xiaoyu;FAN Yanqing(Department of Radiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei Province 430022,P.R.China)

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,分子影像湖北省重点实验室,武汉430022

出　　处：《临床放射学杂志》2022年第1期70-74,共5页Journal of Clinical Radiology

基　　金：国家自然科学基金面上项目(编号:82071921);国家重点研发计划项目(编号:2020YFC0840800)。

摘　　要：目的探讨人类免疫缺陷病毒(HIV)感染者继发耶氏肺孢子菌肺炎(PJP)的CT表现,以提高对该病的认识及诊断水平。方法回顾性分析140例HIV感染者继发PJP的临床及影像资料。依据年龄分为1组:55例(<40岁),2组:58例(40~60岁),3组:27例(≥60岁)。依据影像学表现,将PJP的CT图像分为A型[以磨玻璃密度影(GGO)为主,无实变],B型(实变与GGO并存),C型(囊性病变为主)三种类型。采用Pearson卡方检验比较三组患者性别和CT征象的差异。采用Fisher精确概率法比较CT表现类型。结果 PJP以双肺弥漫分布GGO为主要表现形式(90.0%)。实变63例(45.0%),"月弓征"63例(45.0%),小叶间隔增厚61例(43.6%),肺气囊39例(27.9%),空气支气管征36例(25.7%),线性或网格影32例(22.9%),小结节31例(22.1%),胸腔积液19例(13.6%),"铺路石征"14例(10.0%)。2组病例中"铺路石征"(10/58)较1组(2/55)和3组(2/27)常见;3组小结节(10/27)较1组(14/55)和2组(7/58)常见;3组胸腔积液(8/27)较1组(5/55)和2组(6/58)常见。1、2、3组以上CT征象的差异均有统计学意义(P<0.05)。1组,2组以A型为主要表现形式的概率大于3组,而3组以B型为表现形式的概率大(χ^(2)=15.733,P=0.002)。结论 HIV感染者继发PJP的CT征象有一定的特征,且在不同年龄段患者中有显著差异。CT扫描可为临床诊疗提供重要信息。Objective To explore the computed tomography(CT)features of Pneumocystis jirovecii pneumonia(PJP)in patients with human immunodeficiency virus(HIV)infection.Methods The clinical data and CT images of 140 HIV patients with PJP were analyzed retrospectively.Among 140 cases,there were 55 cases in group 1(<40 years old),58 cases in group 2(40-60 years old)and 27 cases in group 3(≥60 years old).The CT appearances were categorized into three patterns:diffuse ground-glass opacity(GGO)without consolidation(pattern A),consolidation with GGO(pattern B)and cystic lesions mainly(pattern C).Pearson test was performed to compare genders and CT features between three groups.Comparison of image patterns was tested using Fisher′s exact tests.Results Bilateral symmetrical GGO are the typical radiographic features of PJP.The CT findings included consolidation(63 patients),“lunar arch sign”(63 patients),septal line thickening(61 patients),cystic lesions(39 patients),air bronchogram(36 patients),linear or reticular opacities(32 patients),small nodules(31 patients),pleural effusion(19 patients)and crazy paving(14 patients).CT findings suggestive of crazy paving was seen more with group 2(10/58)than group 1(2/55)and 3(2/27);small nodules were seen more with group 3(10/27)than group 1(14/55)and 2(7/58);pleural effusions were seen more with group 3(8/27)than group 1(5/55)and 2(6/58).There were significant differences of the above CT features between these three groups(P<0.05).Group 1 and 2 mainly showed Pattern A,while group 3 mainly showed Pattern B(χ^(2)=15.733,P=0.002).Conclusion The imaging findings of HIV patients with PJP are typical and have great difference in patients of different ages.CT can provide important information for clinical diagnosis and treatment.

关 键 词：耶氏肺孢子菌肺炎 人类免疫缺陷病毒 体层摄影术 X线计算机 磨玻璃密度影 

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