HIV感染人群肺结节术后诊断为肺结核的临床特征分析  

Clinical characteristics analysis of HIV-infected cases diagnosed with tuberculosis after surgery due to pulmonary nodules

作　　者：李蕾蕾 石磊[1] 王琳[1] 李洪伟[1] 徐立然[2] 逄宇 宋言峥[1] Li Leilei;Shi Lei;Wang Lin;Li Hongwei;Xu Liran;Pang Yu;Song Yanzheng(Department of Thoracic Surgery,Shanghai Public Health Clinical Center,Shanghai 201508,China;Guoyi Hall,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450003,China;Bacterial Immunology Research Laboratory,Beijing Chest Hospital,Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China)

机构地区：[1]上海市公共卫生临床中心胸外科,上海201508 [2]河南中医药大学第一附属医院国医堂,郑州450003 [3]首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所细菌免疫研究室,北京101149

出　　处：《中国防痨杂志》2025年第3期266-273,共8页Chinese Journal of Antituberculosis

基　　金：上海市公共卫生临床中心院内课题(KW-GW-2022-26)。

摘　　要：目的:总结HIV感染人群肺结节术后诊断为结核性肺结节患者的临床特点,提升对该人群的诊疗能力。方法:回顾性分析上海市公共卫生临床中心胸外科2015年1月1日至2024年7月1日收治的129例因肺结节行肺切除术的HIV感染患者,其中手术后证实为肺结核的患者14例。收集14例患者的临床资料,包括人口学特征、病史、实验室检查结果及影像学资料,对患者的临床特征进行分析。结果:经手术后确诊为结核性肺结节的14例HIV感染者,大多数(85.7%,12/14)无临床症状,通过体检被发现;10例患者CD4+T淋巴细胞计数<400个/μl,γ干扰素释放试验检测阴性率较高(70.0%,7/10);主要影像学表现为,肺部结节直径在11~20 mm(50.0%,7/14)、实性结节(92.9%,13/14)、形态不规则(71.4%,10/14)、边界模糊(64.3%,9/14),恶性形态学表现包括毛刺(50.0%,7/14)、胸膜牵拉或增厚(50.0%,7/14)、功能显像阳性(64.3%,9/14)。结论:HIV感染者结核性肺结节多数术前无明显临床症状,结核免疫学检测受免疫状态影响可能出现假阴性结果,影像学特征与恶性肿瘤不易鉴别,需要采用综合性诊断方法进行明确诊断。Objective:To summarize the clinical characteristics of HIV-positive patients diagnosed with tuberculous pulmonary nodules after they received surgery due to pulmonary nodules and enhance the diagnosis and treatment capabilities for this group of population.Methods:A retrospective analysis was conducted in 129 HIV-positive patients who underwent lung resection for pulmonary nodules admitted to the Department of Thoracic Surgery of Shanghai Public Health Clinical Center from January 1,2015 to July 1,2024,of which 14 patients were confirmed to be pulmonary tuberculosis after surgery.The clinical data of those 14 patients,including demographic characteristics,medical history,laboratory examination results and imaging data,were collected and their clinical characteristics were analyzed.Results:Among 14 HIV-positive patients who were diagnosed as tuberculous pulmonary nodules after surgery,most of them(85.7%,12/14)were asymptomatic and were found through physical examination.The CD4+T lymphocyte count was less than 400 cells/μl in 10 patients,and the negative rate of IGRA test was higher(70.0%,7/10).The main imaging findings were pulmonary nodules with a diameter of 11-20 mm(50.0%,7/14),solid nodules(92.9%,13/14),irregular shapes(71.4%,10/14),and fuzzy boundaries(64.3%,9/14).There were certain degrees of malignant morphological features,including spiculation(50.0%,7/14),pleural traction or thickening(50.0%,7/14),and positive functional imaging(64.3%,9/14).Conclusion:Most of the patients with tuberculous pulmonary nodules and living with HIV have no obvious clinical symptoms before surgery.Their immunological testing for tuberculosis may have false-negative results influenced by the immune status.It’s a challenge to differentiate tuberculosis from malignant tumors by imaging features.Using comprehensive diagnostic methods for definite diagnosis is recommended.

关 键 词：HIV感染 结节病 肺 肺外科手术 结核 疾病特征 

分 类 号：R512.91[医药卫生—内科学] R521[医药卫生—临床医学] R81