艾滋病合并空洞性肺病变患者的临床和影像学特征  

Clinical and imaging features of AIDS patients complicated with cavitary lung lesions

作　　者：许飞龙 郭朋乐 谢志伟 邓西子 江松峰 丁岩[1] 李青青 李凌华[1] 蔡卫平[1] 陈谐捷[1] Xu Feilong;Guo Pengle;Xie Zhiwei;Deng Xizi;Jiang Songfeng;Ding Yan;Li Qingqing;Li Linghua;Cai Weiping;Chen Xiejie(Department of Infectious Diseases,Guangzhou Eighth People’s Hospital,Guangzhou Medical University,Guangzhou 510060,China)

机构地区：[1]广州医科大学附属市八医院感染病中心,510060

出　　处：《国际流行病学传染病学杂志》2022年第4期263-267,共5页International Journal of Epidemiology and Infectious Disease

基　　金：国家自然科学基金(82072265);广州市基础研究计划民生科技专题(202002020005)。

摘　　要：目的了解艾滋病合并空洞性肺病变患者的临床特征及影像学表现。方法将2015年1月至2021年1月于广州医科大学附属市八医院诊治的52例艾滋病合并空洞性肺病变患者纳入研究。采用CT引导下经皮肺穿刺活检术(CT-PTLB)取肺活组织,根据病理检查结果分成感染组(43例)和肿瘤组(9例),比较组间临床特征、胸部计算机断层成像特征和不同CD4+T淋巴细胞计数所占比例。结果 52例艾滋病合并空洞性肺病变患者中,肺活组织病理检查结果为感染性病变43例(分枝杆菌感染8例,真菌感染35例)和肿瘤病变9例。感染组患者中,<40岁共27例;而肿瘤组患者中,>50岁有8例。52例患者中仅25.0%(13例)接受抗逆转录病毒治疗,主要分布在肿瘤组(8例)。肿瘤组患者仅1例CD4+T淋巴细胞计数<200个/μL,而感染组有41例。与肿瘤组患者比较,感染组患者更易出现发热。胸部计算机断层成像检查显示,感染组多数患者病变边缘可见卫星灶,而肿瘤多数患者病变可见边缘毛刺及分叶。感染组中共42例治愈或好转,肿瘤组中仅2例。结论艾滋病合并空洞性肺病变的主要病因有感染(分枝杆菌感染与真菌感染)与肿瘤,可结合临床症状、影像学特征、是否接受抗反转录病毒治疗与基线CD4+T淋巴细胞计数水平进行鉴别。Objective To understand the clinical and imaging features of AIDS patients complicated with cavitary lung lesions.Methods Fifty-two AIDS patients with cavitary lung lesions treated in Guangzhou Eighth People’s Hospital,Guangzhou Medical University from January 2015 to January 2021 were enrolled in the study.According to the pathological results of lung biopsy by CT-percutaneous lung biopsy(CT-PTLB),the patients were divided into infection group(43 cases)and tumor group(9 cases).The clinical characteristics,chest CT features and the proportion of different CD4+T lymphocyte counts were compared between the two groups.Results Among 52 AIDS patients complicated with cavitary lung lesions,43 cases had infectious lesions by pulmonary biopsy(8 cases with mycobacterial infection,35 cases with fungal infection),and 9 cases had tumor lesions.There were 27 cases who were younger than 40 years old in the infection group,while 8 cases who were older than 50 years old in the tumor group.Of the 52 patients,only 25.0%(13 cases)received antiretroviral therapy,and were mainly distributed in the tumor group(8 cases).Only 1 patient in tumor group had a CD4+T lymphocyte count<200 cells/μL,while 41 patients had CD4+T lymphocyte counts<200 cells/μL in infection group.Compared with the tumor group,patients in the infection group were more prone to fever.Chest CT showed satellite lesions were seen at the edges of the lesions in most patients in the infection group,while most patients in the tumor group had lobe and burr on the edges of the lesions.A total of 42 cases were cured or improved in the infection group,and only 2 cases were cured or improved in the tumor group.Conclusions The main causes of AIDS complicated with cavitary pulmonary lesions are infection(mycobacterial infection and fungal infection)and tumor,which can be differentiated according to clinical symptoms,imaging features,whether or not to receive antiretroviral therapy and baseline CD4+T lymphocyte count.

关 键 词：获得性免疫缺陷综合征 空洞性肺病变 经皮肺穿刺活检 诊断 鉴别 

分 类 号：R512.91[医药卫生—内科学] R563[医药卫生—临床医学]