CAJ | 학술논문

目的探讨艾滋病相关性肺部空洞病变的CT表现.方法回顾性分析经病理证实的85例艾滋病相关性肺部空洞病变患者的全肺CT扫描资料,71例行病灶处HRCT扫描,总结不同病原菌感染导致肺部空洞病变的CT征象,不同疾病间CT征象的比较使用x2检验.结果 85例艾滋病相关性肺部空洞病变的CT表现:(1)肺结核28例:病灶位于上叶27例,单发空洞15例、多发空洞13例、不规则空洞18例,出现钙化灶8例、引流支气管影8例、卫星灶21例、支气管扩张6例、周边条索影13例、胸膜受累10例、淋巴结肿大10例.病灶位于上叶、出现钙化灶、引流支气管影、卫星灶、周边条索影及胸膜受累6种征象在肺结核与非肺结核之间的差异有统计学意义(x2值分别为12.535、26.753、13.944、17.978、11.362、7.796,P值均＜0.01).(2)非结核分枝杆菌肺病6例:病灶位于上叶5例,单发空洞5例、厚壁空洞3例、外壁毛糙6例,出现卫星灶4例、支气管扩张3例.支气管扩张征象在非结核分枝杆菌肺病与非非结核分枝杆菌肺病之间的差异有统计学意义(x2=9.092,P＜0.01)；卫星灶征象在非结核分枝杆菌肺病和肺脓肿、肺真菌病之间的差异有统计学意义(x2值分别为6.785、9.423,P值均＜0.01).(3)肺脓肿12例:多发空洞9例,病灶＞4 cm7例,厚壁空洞9例,外壁毛糙8例,内壁光滑11例,空洞内见液-气平面4例.多发空洞、病灶＞4 cm及空洞内液-气平面3种征象在肺脓肿与非肺脓肿之间的差异有统计学意义(x2值分别为10.390、4.551、7.635,P值均＜0.05).(4)肺真菌病39例；单发空洞33例、规则空洞25例,内壁光滑28例,出现壁结节7例,晕征10例,淋巴结肿大11例.单发空洞征象在肺真菌病与非肺真菌病之间的差异有统计学意义(x2 =11.251,P ＜0.01).结论分析空洞的分布、整体形态及周边情况是艾滋病相关性肺部空洞病变诊断的关键.
목적 탐토애자병상관성폐부공동병변적CT표현.방법 회고성분석경병리증실적85례애자병상관성폐부공동병변환자적전폐CT소묘자료,71례행병조처HRCT소묘,총결불동병원균감염도치폐부공동병변적CT정상,불동질병간CT정상적비교사용x2검험.결과 85례애자병상관성폐부공동병변적CT표현:(1)폐결핵28례:병조위우상협27례,단발공동15례、다발공동13례、불규칙공동18례,출현개화조8례、인류지기관영8례、위성조21례、지기관확장6례、주변조색영13례、흉막수루10례、림파결종대10례.병조위우상협、출현개화조、인류지기관영、위성조、주변조색영급흉막수루6충정상재폐결핵여비폐결핵지간적차이유통계학의의(x2치분별위12.535、26.753、13.944、17.978、11.362、7.796,P치균＜0.01).(2)비결핵분지간균폐병6례:병조위우상협5례,단발공동5례、후벽공동3례、외벽모조6례,출현위성조4례、지기관확장3례.지기관확장정상재비결핵분지간균폐병여비비결핵분지간균폐병지간적차이유통계학의의(x2=9.092,P＜0.01)；위성조정상재비결핵분지간균폐병화폐농종、폐진균병지간적차이유통계학의의(x2치분별위6.785、9.423,P치균＜0.01).(3)폐농종12례:다발공동9례,병조＞4 cm7례,후벽공동9례,외벽모조8례,내벽광활11례,공동내견액-기평면4례.다발공동、병조＞4 cm급공동내액-기평면3충정상재폐농종여비폐농종지간적차이유통계학의의(x2치분별위10.390、4.551、7.635,P치균＜0.05).(4)폐진균병39례；단발공동33례、규칙공동25례,내벽광활28례,출현벽결절7례,훈정10례,림파결종대11례.단발공동정상재폐진균병여비폐진균병지간적차이유통계학의의(x2 =11.251,P ＜0.01).결론 분석공동적분포、정체형태급주변정황시애자병상관성폐부공동병변진단적관건.
Objective To evaluate CT findings of cavitary pulmonary diseases in AIDS.Methods CT findings of cavitary pulmonary diseases were retrospectively analyzed in 85 patients with AIDS.Seventyone of the patients were scanned by HRCT.The CT features of various infectious diseases were summarized and their signs were compared by Chi-square test.Results CT findings of cavitary pulmonary diseases in 85 patients with AIDS included:(1) pulmonary tuberculosis in 28 patients,with lesions in upper lung lobes (27 patients),single cavity (15 patients),multiple cavities (13 patients),irregular cavity (18 patients),calcification(8 patients),communication with bronchia (8 patients),satellite lesions (21 patients),bronchiectasis (6 patients),surrounding cord (13 patients),pleural involvement (10 patients),and lymphadenopathy (10 patients).Tuberculous cavity in AIDS is closely related to the following CT findings:the focus in upper lung lobes,calcification,communication with bronchia,satellite lesions,surrounding cord and pleural involvement (P ＜ 0.01).(2) Non-tuberculous mycobacterial pulmonary infection in 6 patients with the lesions in the upper lung lobes (5 patients),single cavity (5 patients),thick-walled cavity (3 patients),rough outer wall (6 patients),satellite lesions (4 patients),and bronchiectasis (3 patients).Non-tuberculous mycobacterial cavity in AIDS is closely related to CT tinging of bronchiectasis (P ＜ 0.01).There was significant difference of satellite lesions between non-tuberculous mycobacterialpulmonary infection and pulmonary abscess and pulmonary mycosis (P ＜ 0.01).(3) pulmonary abscess in 12 patients with multiple cavities (9 patients),the size of more than 4 cm (7 patients),thick-walled cavity (9 patients),rough outer wall(8 patients),smooth inner wall (11 patients),and air-fluid level inside the cavity (4 patients).Pulmonary abscess in AIDS is closely related to the following CT fingings:multiple cavities,the size of more than 4cm and air-fluid level inside the cavity (P ＜ 0.05).(4) pulmonary mycosis in 39 patients with single cavity (33 patients),regular cavity (25 patients),smooth inner wall (28 patients),a mural nodule (7 patients),halo sign (11 patients),and lymphadenopathy (10 patients).Mycotic cavity in AIDS is closely related to CT finding of single cavity(P ＜ 0.01).Conclusion The key of diagnosis in cavitary pulmonary diseases with AIDS is the distribution,shape,and surrounding manifestation of the lesions.