摘要
目的分析获得性免疫缺陷综合征（AIDS；即“艾滋病”）并发胸部结核患者的高分辨CT（HRCT）征象及其与CD4＋T淋巴细胞计数的相关性。方法选取2013年1月至2017年12月于首都医科大学附属北京地坛医院就诊或住院治疗，并经病理及实验室检查证实或临床确诊的AIDS并发胸部结核患者作为研究对象，共计235例。收集研究对象HRCT征象及CD4＋T淋巴细胞计数资料。将研究对象CD4＋T淋巴细胞计数分为Ⅰ、Ⅱ级（Ⅰ级：CD4＋T淋巴细胞计数〈100×106／L；Ⅱ级：CD4＋T淋巴细胞计数≥100×106／L），分析研究对象CT征象与不同免疫水平的相关性。结果研究对象继发性肺结核、血行播散性肺结核及纵隔淋巴结结核总的发生率分别为66．8％（157／235）、31．9％（75／235）、63．8％（150／235）。CD4＋T淋巴细胞计数Ⅰ、Ⅱ级研究对象中，纵隔淋巴结结核发生率分别为51．9％（122／235）和11．9％（28／235），差异有统计学意义（X2=3．59，P=0．048）。CD4＋T淋巴细胞计数Ⅰ级AIDS并发继发性肺结核患者，HRCT征象中实变影、实变伴空洞、多发空洞的发生率分别为55．4G（87／157）、17．2％（27／157）、10．2％（16／157），均高于CD4＋T淋巴细胞计数Ⅱ级者[分别为13．4％（21／157）、3．8％（6／157）、1．9％（3／157）]，差异均有统计学意义（X2值分别为6．47、8．22、7．47，P值分别为0．014、0．004、0．045）；继发性肺结核发生于上叶前段、右中叶、左舌段的比率[分别为26．1％（41／157）、24．2％（38／157）、27．4％（43／157）]均高于CD4＋T淋巴细胞计数Ⅱ级者[分别为5．7％（9／157）、3．2％（5／157）、3．8％（6／157）]，差异均有统计学意义（X2值分别为0．78、5．40、6．79，P值分别为0．037、0．045、0．039）。结论AIDS并发胸部结核以继发性肺结核和纵隔淋巴结结核为主，其HRCT征象与CD4＋T淋巴细胞的免疫功能损坏程度有关，CD4＋T淋巴细胞计数越低，胸部HRCT征象越复杂、越不典型。
Objective To analyze the high-resolution computed tomography （HRCT） image features in patients with acquired immunodeficiency syndrome （AIDS） complicated with thoracic tuberculosis （TB）, and to investigate the correlation of the HRCT signs with CD4＋ T lymphocyte level. Methods From January 2013 to December 2017, 235 patients who were pathological and laboratory confirmed or clinically diagnosed with AIDS complicated with thoracic TB in Beijing Ditan Hospital affiliated to Capital Medical University were selected as subjects. Data on HRCT signs and CD4＋ T lymphocyte counts of each subject were collected. The CD4＋ T lymphocyte levels of patients were graded to Ⅰ （〈100× 106/L） and Ⅱ（≥100×106/L）. The correlation between the HRCT signs and different immunity levels was analyzed. Results The overall incidence of secondary pulmonary TB, hematogenous disseminated TB, and mediastinal lymph node TB were 66.8% （157/235）, 31.9% （75/235）, and 63.8% （150/235）, respectively. For patients with grade Ⅰ and Ⅱ CD4＋ T lymphocyte level, the incidence of mediastinal lymph node TB was 51.9%（122/235） and 11.9% （28/235）, respectively. The difference was statistically significant （X2 =3.59, P=0. 048）. In AIDS patients complicated with secondary pulmonary TB who had grade Ⅰ CD4＋ T lymphocyte level, the occurrence rates of consolidation, consolidation and cavitation, and multiple cavi tation in the HRCT scan were 55.4% （87/157）, 17.2% （27/157）, and 10. 2% （16/157）, which were higher than those of the patients having grade Ⅱ CD4＋ T lymphocyte level （13.4% （21/157）, 3.8% （6/157）, and 1.9% （3/157））, respectively. The discrepancies were statistically significant （X2= 6.47, 8.22, and 7. 47; P= 0. 014, 0. 004, and 0. 045, respectively）. The incidence of secondary pulmonary TB occurring in the anterior segment of the superior lobe, the right middle lobe, and the left segment of the tongue were higher in cases with grade Ⅰ CD4＋ T lymphocyte level （26.1% （41/157）, 24. 2% （38/157）, and 27.4% （43/157）） compared with cases with grade Ⅱ （5.7% （9/157）, 3.2% （5/157）, and 3.8% （6/157））. The differences were statistically significant （X2 =0.78, 5.40, and 6.79; P=0. 037, 0. 045, and 0. 039, respectively）. Conclusion The thoracic TB complicated in AIDS patients are mainly secondary pulmonary TB and mediastinal lymph node TB. The HRCT signs are related to the degree of damage on the immune function of CD4＋ T lymphocytes. The lower the CD4＋ T lymphocyte count is, the more complex and untypical the chest HRCT signs are.
作者
薛明
李晶晶
闫铄
吕志彬
崔涛
陈七一
张紫欣
杜艳妮
谢汝明
XUE Ming;LlJing-jing;VAN Shuo;LYU Zhi-bin;CUI Tao;CHEN Qi-yi;ZHANG Zi-xin;DU Yan-ni;XIE Ru-ming(Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China)
出处
《中国防痨杂志》
CAS
2018年第7期682-688,共7页
Chinese Journal of Antituberculosis
