误诊为间质性肺疾病的艾滋病合并肺部感染13例分析

目的 对误诊为间质性肺疾病（ILD）的艾滋病（AIDS）合并肺部感染患者临床、影像学及病理学特征进行探讨,以提高对AIDS合并肺部感染的认识.方法 收集我院2005年3月～2010年12月AIDS合并肺部感染患者13例,均具有完整临床资料和肺间质性改变,并复习相关文献.结果 13例患者均为男性,平均年龄50.76岁.HIV感染途径为经输血3例（23.1％）,性传播10例（76.9％）.临床表现为发热8例（61.5％）,进行性加重的呼吸困难9例（69.2％）,咳嗽5例（38.4％）,体重下降7例（53.8％）.有吸烟史9例（69.2％）.最初诊断为非特异性间质性肺炎5例,肺泡蛋白沉积症2例,过敏性肺炎3例,肺组织细胞增生症1例.胸部影像学表现为双侧肺间质纹理改变4例（30.8％）,斑片状磨玻璃影9例（69.2％）.结论 AIDS合并肺部感染临床表现无特异性,临床遇有发热、呼吸困难、低氧血症、体重下降,胸部影像学检查提示间质纹理改变或斑片影等肺间质性改变时,应警惕AIDS合并肺部感染,及时行HIV抗体检查.

Analysis of 13 AIDS complicated with pulmonary infection misdiagnosed as interstitial lung disease

Objective To analyse the clinical, radiological, and pathological characteristics of AIDS complicated with pulmonary infection who were misdiagnosed as interstitial lung disease, and to fur- ther develop our understanding of AIDS complicated with pulmonary infection. Methods Clinical data of 13 AIDS patients with interstitial change of the lung admitted into people＇ s hospital of Yubei district, Chongqing city from March 2005 to December 2010 were collected and analysed, and we reviewed literatures on this subject. Results All patients were male with the average age of 50.76. Three patients （23.1% ） were infected with HIV through blood transfusion, and 10 （76.9%） through sexual intercourse. The most common symptoms were fever （61.5 % ）, progressively aggravated dyspnea （69.2%）, cough （38.4%） , and weight loss （ 53.8% ）. 9 patients were smokers. 5 patients were misdiagnosed as interstitial lung disease,2 patients were pulmonary alveolar proteinosis,3 patients were hypersensitivity pneumonitis, and l patient was pulmonary histiocytosis. Radio~ogical manifestations showed the changes of pulmonary inter- stitial texture（4 cases,30.8% ） and patchy ground glass shadow（9 cases,69.2% ）. Conclusion The manifestations of AIDS complicated with pulmonary infection are non-specific. If patients show fever, dyspnea, hyoxemia, weight loss and interstitial texture changes or pathy shadow of the lungs, we should be alerted that the patients might have AIDS complicated with pulmonary infection, and should test HIV antigens for these patients.