30例艾滋病合并不明原因胸腔积液的病因和诊断分析  

Etiology and diagnosis of 30 cases of AIDS complicated with pleural effusion

作　　者：李志峰[1] 梁联哨 谢周华[1] Li Zhifeng;Liang Lianshao;Xie Zhouhua(Tuberculosis department of Nanning Fourth People's Hospital,Guangxi AIDS Clinical Treatment Center,Nanning 530023,China)

机构地区：[1]南宁市第四人民医院结核科,广西艾滋病临床治疗中心,南宁530023

出　　处：《新发传染病电子杂志》2022年第3期46-49,共4页Electronic Journal of Emerging Infectious Diseases

基　　金：南宁市科学研究与技术开发计划(20183202-2);南宁市科学技术局重点研发计划(20193008-3)。

摘　　要：目的分析艾滋病合并不明原因胸腔积液的病因,探讨其诊断方法。方法收集2017年2月至2020年5月南宁市第四人民医院住院的30例艾滋病合并不明原因胸腔积液患者资料,对其临床表现、实验室检查、影像学、组织病理学等进行回顾性分析。结果30例艾滋病合并不明原因胸腔积液患者中,73.3%(22/30)诊断结核性胸膜炎,20.0%(6/30)为恶性胸腔积液,6.7%(2/30)无法确诊,其中经内科胸腔镜(MT)确诊20例,14例为结核性胸膜炎,6例为恶性胸腔积液,MT确诊率为66.7%(20/30)。HIV阳性患者结核性胸膜炎镜下以胸膜充血肥厚及粘连多见,胸膜组织病理改变以淋巴细胞浸润为主,肉芽肿、干酪样坏死及朗汉斯巨细胞少见。结论艾滋病合并不明原因胸腔积液以结核性胸膜炎最常见,艾滋病合并结核性胸膜炎胸膜组织病理改变以淋巴细胞浸润为主,MT对艾滋病合并不明原因胸腔积液诊断有较好的应用价值。Objective To analyze the etiology of AIDS complicated with unexplained pleural effusion,and to explore its diagnosis method.Method A retrospective analysis of clinical data such as Clinical manifestations,laboratory tests and histopathology of 30 cases of AIDS with unexplained pleural effusion in our institute between February 2017 to May 2020 was performed.Result Among the 30 AIDS patients with unexplained pleural effusion,73.3%were diagnosed with tuberculous pleurisy(22/30),20.0%had malignant pleural effusion(6/30),and 6.7%were undiagnosed(2/30),of which 20 were diagnosed by medical thoracoscopy(MT),14 were tuberculous pleurisy,6 cases were malignant pleural effusion,and the mt diagnosis rate was 66.7%(20/30).In HIV-positive patients with tuberculous pleuritis,pleural hypertrophy and adhesion are more common under thoracoscopic,the pleural histopathological changes are dominated by lymphocytic infiltration.Granulomas,caseous necrosis and langerhans giant cells are rare.Conclusion Tuberculous pleurisy is the most common in the AIDS complicated with unexplained pleural effusion,the pleural histopathological changes of AIDS complicated with tuberculous pleuritis were mainly lymphocyte infiltration,MT is useful in the diagnosis of AIDS complicated with unexplained pleural effusion.

关 键 词：艾滋病 胸腔积液 胸腔镜 病因 诊断 

分 类 号：R512.91[医药卫生—内科学] R561.3[医药卫生—临床医学]