艾滋病合并马尔尼菲青霉菌病胸部CT征象分析

目的通过对艾滋病合并马尔尼菲青霉菌病的胸部CT征象分析,提高认识和诊断水平。方法回顾性纳入22例经病原学确诊为艾滋病合并胸部马尔尼菲青霉菌病的患者,分析其胸部CT,图像作局部放大和高分辨率重组以仔细观察胸部CT特征,对肺部、胸内淋巴结等各种征象进行分类并探讨胸部CT病变的严重程度与CD_4~+T淋巴细胞计数之间的相关性。结果 22例患者的肺部征象主要表现为肺内多发粟粒和小结节17例(77.3%),可弥漫性分布或少量散发分布,其次为低密度结节或肿块9例(占40.9%),可实性或伴发空洞,另4例患者表现为段以上支气管受侵并狭窄(18.2%),上述患者常合并小叶间隔增厚、支气管血管束增粗及肺气囊等征象。多发淋巴结肿大18例(81.8%),表现明显低密度,增强无强化或轻度环状强化,位于淋巴结多个分区,以7、4R、2R、10R、11R区及左X等区域为主。15例外周血CD_4~+T淋巴细胞25个/μl患者,肺内病变类型多,累及范围较广泛。但CD_4~+T淋巴细胞计数与病变种类数、胸内淋巴结肿大区域数之间无相关性(r=-0.123和-0.349,P0.05)。结论艾滋病合并马尔尼菲青霉菌病的胸部CT表现具有一定特点;胸部病变的严重程度与CD_4~+T淋巴细胞计数降低可能有关。认识这些胸部CT征象,结合相关实验室和病原学检查,对诊断具有重要的价值。

CT features of Penicillium marneffei opportunistic infection in AIDS

Objective To analyze the chest CT features of Penicillium marneffei opportunistic infection in patients with acquired immune deficiency syndrome (AIDS).Methods High-resolution chest CT of 22 patients with AIDS and Penicillium marneffei infection was retrospectively analyzed.The CT appearance of lung lesions and lymphadenopathy was correlated with CD4+ lymphocyte count.Results CT showed bilateral diffuse or scattered pulmonary micronodules (17/22,77.3％),low-density lung nodules or masses (9/22,40.9％),segmental bronchial narrowing (4/22,18.2％) as well as interlobular septal thickening,dilatation of bronchovascular bundles,bronchial wall thickening,and lung air sacs.Hypodense,non-or mildly rim-enhancing lymph node enlargement in the mediastinum and hila (18/22,81.8％).In 15 patients with CD4+ lymphocytes count ＜25/μl,the puhnonary lesions were more widespread.However,the CD4+ lymphocyte count did not correlate significantly (P＞0.05) with the types of lung lesions (r=-0.123) and extent of lymphadenopathy (r=-0.349).Conclusion Lung lesions and lymphadenopathy are more extensive and severe with lower CD4+ lymphocyte count in patients with AIDS complicated by Penicilliosis marneffei.