CAJ | 학술논문

目的探讨艾滋病(AIDS)合并肺弥漫粟粒结节的高分辨率CT(HRCT)影像特点及鉴别诊断.方法回顾性分析112例单一病原感染的AIDS患者双肺CT及HRCT表现,分析不同病原感染的双肺弥漫粟粒结节的分布特点,将其伴随的CT征象采用x2检验进行分析.结果 112例单一病原感染的AIDS合并肺弥漫粟粒结节患者中结核分枝杆菌57例、真菌45例(马尔尼菲青霉菌34例、曲霉菌9例、毛霉菌2例),细菌10例(葡萄球菌5例、肺炎克雷伯菌3例、缓症链球菌1例、麻疹挛生球菌1例).结核分枝杆菌感染的弥漫粟粒结节分布类型:47例随机分布,18例为小叶中心分布,其中8例为随机分布与小叶中心分布并存；真菌感染的弥漫粟粒结节分布类型:36例随机分布,16例为小叶中心分布,其中7例为随机分布与小叶中心分布并存；细菌感染的弥漫粟粒结节分布类型:10例为小叶中心分布.马尔尼菲青霉菌病与结核间胸部及腹部CT伴随征象经x2检验:肺弥漫粟粒结节伴随胸腔积液与AIDS合并结核分支杆菌感染(31例)的诊断密切相关,马尔尼菲青霉菌病5例(x2=14.024,P＜0.01).肺弥漫粟粒结节伴随肠系膜淋巴结肿大与AIDS合并马尔尼菲青霉病(5例)的诊断密切相关,结核分支杆菌感染5例(x2=23.015,P＜0.01).结论肺弥漫粟粒结节的鉴别诊断仅依据粟粒结节的形态、大小有一定困难,如结合其伴随征象对鉴别诊断有一定的帮助.
목적 탐토애자병(AIDS)합병폐미만속립결절적고분변솔CT(HRCT)영상특점급감별진단.방법 회고성분석112례단일병원감염적AIDS환자쌍폐CT급HRCT표현,분석불동병원감염적쌍폐미만속립결절적분포특점,장기반수적CT정상채용x2검험진행분석.결과 112례단일병원감염적AIDS합병폐미만속립결절환자중결핵분지간균57례、진균45례(마이니비청매균34례、곡매균9례、모매균2례),세균10례(포도구균5례、폐염극뢰백균3례、완증련구균1례、마진련생구균1례).결핵분지간균감염적미만속립결절분포류형:47례수궤분포,18례위소협중심분포,기중8례위수궤분포여소협중심분포병존；진균감염적미만속립결절분포류형:36례수궤분포,16례위소협중심분포,기중7례위수궤분포여소협중심분포병존；세균감염적미만속립결절분포류형:10례위소협중심분포.마이니비청매균병여결핵간흉부급복부CT반수정상경x2검험:폐미만속립결절반수흉강적액여AIDS합병결핵분지간균감염(31례)적진단밀절상관,마이니비청매균병5례(x2=14.024,P＜0.01).폐미만속립결절반수장계막림파결종대여AIDS합병마이니비청매병(5례)적진단밀절상관,결핵분지간균감염5례(x2=23.015,P＜0.01).결론 폐미만속립결절적감별진단부의거속립결절적형태、대소유일정곤난,여결합기반수정상대감별진단유일정적방조.
Objective To explore HRCT appearances and differential diagnosis of diffuse pulmonary miliary nodules in patients with acquired immunodeficiency syndrome(AIDS).Methods The thoracic CT scans obtained in 112 AIDS patients with diffuse miliary nodules and one single diagnosis were retrospectively analyzed for distribution of nodules and for coexistent findings of consolidation,cavity formation,"tree-inbud" pattern,nodules (10-30 mm in diameter),lymphadenopathy,and hepatoslpenomegaly.Results Of the 112 patients,57 had mycobacterium tuberculosis infections,45 had fungal infections (34 cases of marneffei penicillium,9 aspergillus,2 mucomycosis),10 had bacterial infections (5 cases of staphylococcus,3 klebsiella pneumoniae,1 streptococcus mitis,and 1 measles twin cocci).The predominant distribution pattern of tuberculous and fungal infections was random distribution.Lobular center distribution and the coexistence of random distribution and lobular center distribution were also observed.Patients with bacterial infections had a lobular center distribution.Of all the 112 patients,CT findings were compared between penicilliosis marneffei and tuberculosis infections.The presence of pleural effusion was closely related to mycobacterium tuberculosis (31 vs.5 x2 =14.024,P ＜ 0.01),while lymphadenopathy in the small bowel mesentery was related to Penicillium marneffei infection (17 vs.5 x2 =23.015,P ＜ 0.01).Conclusions In patients with AIDS who have diffuse pulmonary miliary nodules at HRCT,distribution of nodules were of no use in the differentiation of potential infectious causes.Other coexistent findings may contribute to the differential diagnosis.