艾滋病与艾滋病毒感染者48例临床影像与病理分析
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摘要
目的探讨艾滋病(AIDS)患者和艾滋病毒(HIV)感染者的临床、影像与病理学表现之间的关系。方法回顾性分析AIDS高发区48例患者的临床、影像学与病理学检查资料。所有病例均行影像学检查,33例行病理学检查。结果本组病例均确认HIV感染,其中男30例,女18例。33例经血液传播,包括输血19例,非法采血14例;经性传播4例;1例儿童患者推测为母婴垂直传播,其余传播途径不明。30例因外科疾病入院治疗,临床和影像学诊断40余种疾病,包括骨折6例,创伤2例,肺病2例,肝病3例,消化道疾病6例,恶性肿瘤6例,良性肿瘤5例;经病理确诊AIDS相关疾病14例,包括淋巴瘤2例,艾滋病相关淋巴结病变3例,结核病6例,淋巴结隐球菌病1例,弓形虫肺炎1例,肺部巨细胞病毒及曲霉菌混合感染1例;其他均非AIDS指征性疾病,包括恶性肿瘤4例,良性肿瘤5例。均与CD4+T细胞计数无相关性。结论 AIDS的诊断需要参照流行病学史、临床表现、实验室检查(确定HIV感染及免疫状态)、影像学检查(确定病变部位和范围)以及病理学检查(确定病变性质、类型,特别是肿瘤性病变),实行五结合,才能获得可靠诊断。
Objective To explore the relationship between the clinical, imaging and pathological appearance. Methods 48 cases of AIDS patients and HIV infected person from the high-incidente area of AIDS were detected radiologically in all cases and pathologically in 33 cases. The examination results were analyzed retrospectively. Results All cases, including 30 men and 18 women, were confirmed to be infected by HIV, and 33 cases were infected by blood including 19 cases by blood transfusion and 14 by illegal blood collection. 4 cases were infected by sexual transmission, 1 child might be infected by his mother, while other transmitted ways in others were unknown. There are 30 patients admitted to hospital for surgical diseases. Among them, more than 40 kinds of diseases were diagnosed by clinician combined with imaging examinations including fracture in 6 cases, trauma in 2 cases, pulmonary diseases in 2 cases, liver diseases in 3 cases, gastrointestinal diseases in 6 cases, malignancies in 6 cases and benign tumors in 5 cases. 14 cases of AIDS related diseases were confirmed by pathologists including lymphoma in 2 patients, lymphadenopathy related to AIDS in 3 patients, tuberculosis in 6 patients, and 1 case of cryptococcosis in lymph node, 1 case of toxoplasma pneumonitis, and 1 case of pulmonary mixed infection with cytomegalovirus(CMV)and aspergillus,respectively. The other diseases are non-indicated diseases to AIDS consisted of4 patients suffered from malignant tumors, and 5 from benign tumors, all of which were found no relationship to the CD4~+ cells counts. Conclusions The reliable diagnosis of AIDS must relay on the combination of the 5 items including epidemiologic history, clinical presentations, laboratory examination to confirm the HIV infection and immune state, imaging inspection to make sure the location and bound of the lesions, and pathological detection to determine the properties and kinds of the lesions especially for the tumors.
Objective To explore the relationship between the clinical, imaging and pathological appearance. Methods 48 cases of AIDS patients and HIV infected person from the high-incidente area of AIDS were detected radiologically in all cases and pathologically in 33 cases. The examination results were analyzed retrospectively. Results All cases, including 30 men and 18 women, were confirmed to be infected by HIV, and 33 cases were infected by blood including 19 cases by blood transfusion and 14 by illegal blood collection. 4 cases were infected by sexual transmission, 1 child might be infected by his mother, while other transmitted ways in others were unknown. There are 30 patients admitted to hospital for surgical diseases. Among them, more than 40 kinds of diseases were diagnosed by clinician combined with imaging examinations including fracture in 6 cases, trauma in 2 cases, pulmonary diseases in 2 cases, liver diseases in 3 cases, gastrointestinal diseases in 6 cases, malignancies in 6 cases and benign tumors in 5 cases. 14 cases of AIDS related diseases were confirmed by pathologists including lymphoma in 2 patients, lymphadenopathy related to AIDS in 3 patients, tuberculosis in 6 patients, and 1 case of cryptococcosis in lymph node, 1 case of toxoplasma pneumonitis, and 1 case of pulmonary mixed infection with cytomegalovirus(CMV)and aspergillus,respectively. The other diseases are non-indicated diseases to AIDS consisted of4 patients suffered from malignant tumors, and 5 from benign tumors, all of which were found no relationship to the CD4~+ cells counts. Conclusions The reliable diagnosis of AIDS must relay on the combination of the 5 items including epidemiologic history, clinical presentations, laboratory examination to confirm the HIV infection and immune state, imaging inspection to make sure the location and bound of the lesions, and pathological detection to determine the properties and kinds of the lesions especially for the tumors.
引文
[1]李太生，王福生，高福.中国艾滋病诊疗指南(2018版)[J].新发传染病电子杂志，2019,4(2):65-84.
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[6]李宏军.实用艾滋病影像学[M].北京:人民卫生出版社，2012:33-39.
[7]李宏军，张玉忠，程敬亮.八例人类获得性免疫缺陷综合征患者尸体的病理与影像表现对照分析[J].中华放射学杂志，2009,43(11):1196-1200.
[8]王岚，郑锡文.经静注毒品及采供血传播艾滋病的流行病学研究[J].中华流行病学杂志，2003,24(11):1057-1059.
[9]刘德纯.充分发挥临床医生在艾滋病防治中的重要作用[J].中国基层医药，2007,14(3):517-518.
[10]刘德纯.诊断艾滋病的临床指征[J].淮海医药，2007,25(4):380-383.
[11]刘德纯.病理学检验在艾滋病防治中的应用与意义[J].中国性病艾滋病防治，1998,4（增刊）：193-195.
[12]刘德纯.感染性疾病的病理学诊断[J].临床与实验病理学杂志，2014,30(7):777-780.
[13]马韵，何如崑.艾滋病相关淋巴结病的病理诊断[J].中华病理学杂志，2005,34(12):776-779.
[14]卢洪洲，汤一苇.感染性疾病的基因诊断[J].国外医学流行病学传染病学分册，2002,29(5):257-259.
[15]刘德纯，刘涛.皖北地区获得性免疫缺陷综合征2例报告及启示[J].蚌埠医学院学报，2008,33(1):35-37.
[16]刘德纯，李宏军.艾滋病合并恶性肿瘤10例临床病理分析[J].蚌埠医学院学报，2015,40(11):1488-1491.
[17]雅克WAJ里德，约翰R马西森.艾滋病临床影像诊断[M].柳学国，谢学斌，谈高主译，天津科技翻译出版公司，2001:39-48.
[2]中国疾病预防控制中心，性病艾滋病预防控制中心，性病控制中心.2017年12月全国艾滋病性病疫情[J].中国艾滋病性病，2018,24(2):69.
[3]刘德纯.我国艾滋病流行与传播30年回顾[J].新发传染病电子杂志，2017,2(1):50-52.
[4]刘德纯.艾滋病临床病理学[M].合肥:安徽科学技术出版社，2002:56-58.
[5]李宏军，李宁.艾滋病影像与解剖、病理对照图谱[M].北京:人民卫生出版社，2008:19-22.
[6]李宏军.实用艾滋病影像学[M].北京:人民卫生出版社，2012:33-39.
[7]李宏军，张玉忠，程敬亮.八例人类获得性免疫缺陷综合征患者尸体的病理与影像表现对照分析[J].中华放射学杂志，2009,43(11):1196-1200.
[8]王岚，郑锡文.经静注毒品及采供血传播艾滋病的流行病学研究[J].中华流行病学杂志，2003,24(11):1057-1059.
[9]刘德纯.充分发挥临床医生在艾滋病防治中的重要作用[J].中国基层医药，2007,14(3):517-518.
[10]刘德纯.诊断艾滋病的临床指征[J].淮海医药，2007,25(4):380-383.
[11]刘德纯.病理学检验在艾滋病防治中的应用与意义[J].中国性病艾滋病防治，1998,4（增刊）：193-195.
[12]刘德纯.感染性疾病的病理学诊断[J].临床与实验病理学杂志，2014,30(7):777-780.
[13]马韵，何如崑.艾滋病相关淋巴结病的病理诊断[J].中华病理学杂志，2005,34(12):776-779.
[14]卢洪洲，汤一苇.感染性疾病的基因诊断[J].国外医学流行病学传染病学分册，2002,29(5):257-259.
[15]刘德纯，刘涛.皖北地区获得性免疫缺陷综合征2例报告及启示[J].蚌埠医学院学报，2008,33(1):35-37.
[16]刘德纯，李宏军.艾滋病合并恶性肿瘤10例临床病理分析[J].蚌埠医学院学报，2015,40(11):1488-1491.
[17]雅克WAJ里德，约翰R马西森.艾滋病临床影像诊断[M].柳学国，谢学斌，谈高主译，天津科技翻译出版公司，2001:39-48.