肺结核合并人类免疫缺陷病毒感染患者的胸部CT特征分析
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摘要
目的分析肺结核合并人类免疫缺陷病毒(HIV)感染患者的胸部电子计算机断层扫描(CT)特征,为临床诊断和治疗工作提供研究依据。方法选取2015年6月-2017年12月医院诊治的70例肺结核合并HIV感染患者作为病例组,选取同期70例单纯肺结核患者作为对照组。对两组患者的胸部CT表现特征进行对比和分析。结果两组患者均以男性居多,临床表现多为消瘦、咳嗽咳痰、盗汗等,差异均无统计学意义。病例组患者肺部病灶分布以二叶和三叶以上为主,对照组患者的肺部病灶分布以一叶为主,差异有统计学意义(P<0.05)。病例组患者肺部CT表现以斑片阴影、片阴影、条索阴影、栗粒阴影居多,而对照组患者以结节阴影、斑点阴影居多。病例组患者中出现纵膈淋巴结增大、胸腔积液、肺外结核等CT表现的比例较多,对照组患者中出现空洞、钙化等CT表现的比例较多,两组比较差异均有统计学意义(P<0.05)。结论肺结核合并HIV感染患者的胸部CT表现具有一定的特征性,能够作为辅助诊断的手段之一,临床医师应综合应用包括影像学检查在内的多种诊断方法,从而提高诊断和治疗效果。
OBJECTIVE To investigate the chest computed tomography(CT)features of the pulmonary tuberculosis patients complicated with human immunodeficiency virus(HIV)infection so as to provide guidance for clinical diagnosis and treatment.METHODS Totally 70 pulmonary tuberculosis patients complicated with HIV infection who were treated in hospitals from Jun 2015 to Dec 2017 were chosen as the case group,meanwhile,70 single pulmonary tuberculosis patients were set as the control group.The chest CT manifestations were observed and compared between the two groups of patients.RESULTS The male patients were dominant among the two groups of patients;the emaciation,cough and expectoration and night sweat were the major clinical manifestations,and there were no significant differences.The two leaves and more than three leaves of pulmonary lesions were dominant among the patients in the case group,and the one leave of pulmonary lesions was dominant among the patients in the control group,and there was significant difference(P<0.05).The chest CT of the patients in the case group was mainly characterized by patchy shadow,shadow,shadow bands,and miliary shadows,while the chest CT of the patients in the control group was mainly characterized by nodular shadows and shadow spots.The patients with the CT manifestations such as mediastinal lymphadenovarix,pleural effusion and extra pulmonary tuberculosis were dominant in the case group,while the patients with the CT manifestations such as cavity and calcification were dominant in the control group,and there were significant differences between the two groups(P<0.05).CONCLUSION The chest CT manifestations of the pulmonary tuberculosis patients complicated with HIV infection show certain characteristics,which can be used as one of means for auxiliary diagnosis.It is necessary for clinicians to comprehensively use multiple diagnosis methods including the imageological examination so as to improve the effect of diagnosis and treatment.
OBJECTIVE To investigate the chest computed tomography(CT)features of the pulmonary tuberculosis patients complicated with human immunodeficiency virus(HIV)infection so as to provide guidance for clinical diagnosis and treatment.METHODS Totally 70 pulmonary tuberculosis patients complicated with HIV infection who were treated in hospitals from Jun 2015 to Dec 2017 were chosen as the case group,meanwhile,70 single pulmonary tuberculosis patients were set as the control group.The chest CT manifestations were observed and compared between the two groups of patients.RESULTS The male patients were dominant among the two groups of patients;the emaciation,cough and expectoration and night sweat were the major clinical manifestations,and there were no significant differences.The two leaves and more than three leaves of pulmonary lesions were dominant among the patients in the case group,and the one leave of pulmonary lesions was dominant among the patients in the control group,and there was significant difference(P<0.05).The chest CT of the patients in the case group was mainly characterized by patchy shadow,shadow,shadow bands,and miliary shadows,while the chest CT of the patients in the control group was mainly characterized by nodular shadows and shadow spots.The patients with the CT manifestations such as mediastinal lymphadenovarix,pleural effusion and extra pulmonary tuberculosis were dominant in the case group,while the patients with the CT manifestations such as cavity and calcification were dominant in the control group,and there were significant differences between the two groups(P<0.05).CONCLUSION The chest CT manifestations of the pulmonary tuberculosis patients complicated with HIV infection show certain characteristics,which can be used as one of means for auxiliary diagnosis.It is necessary for clinicians to comprehensively use multiple diagnosis methods including the imageological examination so as to improve the effect of diagnosis and treatment.
引文
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[14]徐海亮,冯喜英,王玉清,等.肺结核患者多种相关免疫细胞因子的研究进展[J].中华肺部疾病杂志(电子版),2017,10(2):220-222.
[15]唐怡敏,叶涛生,邓国防,等.艾滋病并发菌阴肺结核诊治中支气管肺泡灌洗液检测的应用进展[J].结核病与肺部健康杂志,2017,5(1):68-72.
[16]曾令延,陈根铭,黄福城,等.肺结核抗痨过程中病灶进展的影像学表现及误诊分析[J].实用放射学杂志,2016,32(11):1688-1691,1716.
[17]杨振.基于CT的肺结核患者病理分析及疗效评价[J].安徽理工大学学报(自然科学版),2017,37(3):79-83.
[2] Hochberg NS,Sarkar S,Horsburgh CR Jr,et al.Comorbidities in pulmonary tuberculosis cases in Puducherry and Tamil Nadu,India:opportunities for intervention[J].PLoS One,2017,12(8):e0183195.
[3] Walaza S,Tempia S,Dreyer A,et al.The burden and clinical presentation of pulmonary tuberculosis in adults with severe respiratory illness in a high human immunodeficiency virus prevalence setting,2012-2014[J].Open Forum Infect Dis,2017,4(3):ofx116.
[4]徐向前,鹿振辉,陆城华,等.中医药治疗耐多药肺结核的研究近况[J].中华中医药杂志,2017,32(4):1653-1655.
[5] Rockwood N,Sirgel F,Streicher E,et al.Low frequency of acquired isoniazid and rifampicin resistance in rifampicinsusceptible pulmonary tuberculosis in a setting of high HIV-1infection and tuberculosis coprevalence[J].J Infect Dis,2017,216(6):632-640.
[6] O'Connor DE,Frederix K,Saito S,et al.Pulmonary tuberculosis diagnostic practices among people living with the human immunodeficiency virus in Lesotho[J].Int J Tuberc Lung Dis,2017,21(10):1133-1138.
[7] Ahmed BHH,Manel M,Mohamed D,et al.Glutaraldehyde test for the rapid diagnosis of pulmonary and extra-pulmonary tuberculosis in an area with high tuberculosis incidence[J].Mem Inst Oswaldo Cruz,2017,112(11):779-784.
[8] Mathur M,Badhan RK,Kumari S,et al.Radiological manifestations of pulmonary tuberculosis-a comparative study between immunocompromised and immunocompetent patients[J].J Clin Diagn Res,2017,11(9):TC06-TC09.
[9]卫生部传染病标准专业委员会.艾滋病和艾滋病病毒感染诊断标准[J].中国艾滋病性病,2012,18(4):272-275.
[10]邹级谦.肺结核诊断标准[J].结核病健康教育,2008,17(1):7-9.
[11] Seri B,Koffi A,Danel C,et al.Prevalence of pulmonary tuberculosis among prison inmates:a cross-sectional survey at the correctional and detention facility of Abidjan,Cote d'Ivoire[J].PLoS One,2017,12(7):e0181995.
[12] Yan L,Zhang Q,Xiao H.Clinical diagnostic value of simultaneous amplification and testing for the diagnosis of sputum-scarce pulmonary tuberculosis[J].BMC Infect Dis,2017,17(1):545.
[13] De Groote MA,Sterling DG,Hraha T,et al.Discovery and validation of a six-marker serum protein signature for the diagnosis of active pulmonary tuberculosis[J].J Clin Microbiol,2017,55(10):3057-3071.
[14]徐海亮,冯喜英,王玉清,等.肺结核患者多种相关免疫细胞因子的研究进展[J].中华肺部疾病杂志(电子版),2017,10(2):220-222.
[15]唐怡敏,叶涛生,邓国防,等.艾滋病并发菌阴肺结核诊治中支气管肺泡灌洗液检测的应用进展[J].结核病与肺部健康杂志,2017,5(1):68-72.
[16]曾令延,陈根铭,黄福城,等.肺结核抗痨过程中病灶进展的影像学表现及误诊分析[J].实用放射学杂志,2016,32(11):1688-1691,1716.
[17]杨振.基于CT的肺结核患者病理分析及疗效评价[J].安徽理工大学学报(自然科学版),2017,37(3):79-83.