摘要
目的探讨胸部CT在评估艾滋病相关肺孢子菌肺炎宿主免疫状态中的应用价值。资料与方法回顾性分析符合艾滋病相关肺孢子菌肺炎临床诊断标准的82例患者的胸部CT薄层图像,根据其特征性CT表现的范围及密度进行CT综合定量评分,获取评分值,并与最近的CD_4~+T淋巴细胞计数进行相关性分析,通过受试者工作特征曲线分析,获取CT综合定量评分值预测CD_4~+T淋巴细胞绝对计数<50个/μl的最佳临界值。结果艾滋病相关肺孢子菌肺炎特征性病变的CT综合定量评分值与最近CD_4~+T淋巴细胞计数呈线性负相关(r=-0.47,P<0.01)。以CD_4~+T淋巴细胞绝对计数<50个/μl为阈值,通过受试者工作特征曲线分析,得出相应CT综合定量评分预测值为>48.25分,其曲线下面积为0.80(P<0.01),敏感度为83.10%,特异度为73.90%,阳性预测值为89.09%,阴性预测值为50.67%。结论胸部CT定量评分有助于初步预测艾滋病相关肺孢子菌肺炎宿主的免疫状态,对早期诊疗及评估预后具有重要的临床参考价值。
Purpose To explore the application value of chest CT in assessing host immune status of acquired immunodeficiency syndrome(AIDS)-related pneumocystis jirovecii pneumonia. Materials and Methods Chest CT images of 82 patients that met clinical diagnostic criteria for AIDS-related pneumocystis pneumonia were retrospectively analyzed. CT comprehensive quantitative scoring was performed as per the range and density of characteristic CT findings, and the scores obtained were used for statistical correlation analysis with up-to-date CD_4~+ T lymphocyte counts. Meanwhile, CT comprehensive quantitative scores obtained by analyzing the receiver operating characteristic curve were used for estimation of the optimal cut-off value of CD_4~+ T lymphocytes whose absolute counting<50/μl. Results The CT comprehensive quantitative scores of characteristic lesions of AIDS-related pneumocystis pneumonia bore low linear negative correlation with the up-to-date CD_4~+ T lymphocyte counts(r=-0.47, P<0.01). By analyzing the receiver operating characteristic curve, the predicated value of corresponding CT comprehensive quantitative score reached>48.25 points, the area under curve was 0.80(P<0.01), the sensitivity was 83.10%, the specificity was 73.90%, the positive predictive value was 89.09%, and the negative predictive value was 50.67%, with the absolute counting of CD_4~+ T lymphocytes<50/μl being the threshold value. Conclusion Chest CT quantitative scoring is conducive to preliminary prediction of host immune status of AIDS-related pneumocystis pneumonia,featuring essential clinical reference value for diagnosis and treatment in early stage as well as prognosis evaluation.
引文
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