新发传染病电子杂志2025，Vol.10Issue(4)：52-57,6.DOI:10.19871/j.cnki.xfcrbzz.2025.04.009
HIV感染/AIDS患者并发耐药肺结核的临床影像特征分析
Clinical and imaging features of drug-resistant pulmonary tuberculosis in HIV/AIDS patients
摘要
Abstract
Objective To analyze and compare the clinical manifestations and computed tomography(CT)findings of HIV/AIDS patients with drug-resistant pulmonary tuberculosis(DR-PTB),and observe the dynamic changes of CT findings.Method The clinical and CT findings of 20 patients with HIV/AIDS diagnosed DR-PTB from May 2018 to February 2024 were analyzed retrospectively.Chest CT signs including micronodules,tree-in-bud appearance,consolidation,cavity,bronchial lesion,emphysema,pleural effusion and lymphadenopathy were analyzed,and their CT features,lesion involvement extent,and dynamic changes were compared between groups.Result The main clinical manifestations of DR-PTB in HIV/AIDS patients were cough(85.00%)and fever(65.00%).Micronodules and tree-in-bud appearance were the most frequent CT abnormalities and were seen in all DR-PTB patients(100.00%).Consolidations,bronchial lesions,lymphadenopathy,pleural effusion and cavities were found in DR-PTB patients with rate of 85.00%,70.00%,70.00%,55.00%and 50.00%respectively.The lesion distribution in extensively drug-resistant pulmonary tuberculosis(XDR-PTB)patients was the widest,followed by multidrug-resistant pulmonary tuberculosis(MDR-PTB)and rifampicin-resistant pulmonary tuberculosis(RR-PTB)patients.As for Chest CT features and clinical manifestation,there were no significant differences between different DR-PTB types and between initial treatment and retreatment groups(P＞0.05).3 cases of hematogenous disseminated pulmonary tuberculosis with micronodules appeared in RR-PTB,MDR-PTB and XDR-PTB.The mean CD4+T lymphocytes were 38.67(20.00,55.00)cells/μl.The proportion of cavities in the retreatment group was 66.67%,which was higher than that in the initial treatment group(42.86%),which manifested thick-walled cavities involving multiple lobes(＞3 lobes),but there was no statistically significant difference(P＞0.05).Among 16 follow-up patients,symptoms improved in 14 patients(87.50%),showing lesion absorption,1 patients(6.25%)died showing increased lesions,and chest lesions didn't change in 1 patient(6.25%).Conclusion The CT findings of different DR-PTB in patients with HIV/AIDS were similar,and are related to the state of immunosuppression and tuberculosis treatment history.In the immunosuppressive state,CT findings are atypical,and hematogenous disseminated pulmonary tuberculosis is prone to occur.XDR-PTB tends to have more extensive distribution,the proportion of cavity in retreatment DR-PTB was high relatively.关键词
人类免疫缺陷病毒/获得性免疫缺陷综合征/耐药肺结核/计算机断层扫描/影像特征Key words
Human immunodeficiency virus/Acquired immune deficiency syndrome/Drug-resistant pulmonary tuberculosis/Computed tomography/Imaging feature分类
医药卫生引用本文复制引用
黄华,陈世林,周昀,罗伟军,郑秋婷,邓莹莹..HIV感染/AIDS患者并发耐药肺结核的临床影像特征分析[J].新发传染病电子杂志,2025,10(4):52-57,6.基金项目
1.深圳市盐田区科技计划项目(YTWS20230205) （YTWS20230205）
2.深圳市卫生健康菁英人才项目 （）
3.深圳市高水平医院建设专项经费(2022108) （2022108）
