AIDS合并肺结核肺部影像学分析

目的探讨AIDS合并肺结核的肺部影像学特征。方法收集89例AIDS合并肺结核患者的临床资料、X线胸片和肺部CT影像学检查资料，并进行分析。结果原发型肺结核5例（5．62％），以儿童原发综合征为主，表现为肺内原发灶、淋巴管炎和肿大淋巴结组成的哑铃状“双极影”。血行播散型肺结核19例（21．35％），其中12例为急性血行播散型肺结核，表现为全肺野大小、密度、分布“三均匀”特点，7例为亚急性或慢性血行播散型肺结核，表现为两肺多发大小不等的结节。继发型肺结核65例（73．03％），病变累及单叶多见，两叶受累次之，三叶以上受累较少；右上肺叶为最易发部位，≥3个肺叶受累患者多伴空洞形成和播散病灶；病变形态多样复杂，但以典型浸润病灶常见（43／65）。结论AIDS合并肺结核主要为继发型肺结核和血行播散型肺结核。

Pulmonary imaging of AIDS patients combined with pulmonary tuberculosis

Objective To investigate the pulmonary imaging features of AIDS patients combined with pulmonary tuberculosis. Methods The clinical data and X-ray and lung CT imaging data of 89 AIDS patients combined with pulmonary tuberculosis were collected and analyzed. Results Primary pulmonary tuberculosis occurred in 5 patients （5.62%）, mainly in children with primary syn- drome, manifested as pulmonary primary lesion, lymphangitis, and dumbbell-shaped ＂bipolar shadow＂ as a result of lymph node enlargement. Among 19 patients （21.35%） with hematogenous disseminated pulmonary tuberculosis, 12 had acute hematogenous disseminated pulmonary tuberculosis, characteristic of ＂three uniform＂ in size, density and distribution in the whole lung field; 7 patients had subacute and chronic hematogenous disseminated pulmonary tuberculosis with multiple bilateral pulmonary nodules in different sizes. Sixty-five patients （73.03%） had secondary pulmonary tuberculosis, with lesions the most commonly seen in single lobe, secondly in two lobes, and the least in more than three lobes; lesions were the most likely to occur in the right upper lobe; patients with more than 3 lobes affected were accompanied with cavity formation and disseminated multi-lesions; the morphology of the lesions was diverse and complex, but the typical infihation of lesions was the commonest （43/65）. Conclusions Secondary pulmonary tuberculosis and hematogenous disseminated pulmonary tuberculosis are the most frequent in AIDS combined with pulmonary tuberculosis.