HIV感染/AIDS患者并发耐药肺结核的临床影像特征分析

doi:10.19871/j.cnki.xfcrbzz.2025.04.009

摘要/Abstract

摘要： 目的分析和比较HIV感染/AIDS患者并发不同类型耐药肺结核的临床和影像特征,观察治疗后肺内病灶影像动态变化。方法回顾性分析2018年5月至2024年2月确诊的20例HIV感染/AIDS并发耐药肺结核患者的临床和CT影像资料,分析肺部微结节、树芽征、实变、空洞、支气管病变、肺气肿、胸腔积液以及淋巴结肿大等胸部CT影像征象,比较HIV感染/AIDS患者并发不同类型耐药肺结核的CT特征、病变累及范围以及动态变化特征。结果 HIV感染/AIDS患者并发耐药肺结核的临床表现主要为咳嗽（17例）、发热（13例）。微结节、树芽征等是最常见的CT影像表现,在所有耐多药肺结核及广泛耐药肺结核患者中均可见（20例）。其他CT影像表现包括实变（17例）、支气管病变（14例）、肺门及纵隔淋巴结肿大（14例）、胸腔积液（11例）、空洞（10例）等。广泛耐药肺结核患者肺内病变分布范围更广,其次为耐多药肺结核、利福平耐药肺结核。将不同耐药肺结核类型、初治及复治耐药肺结核患者的临床表现及CT影像征象进行组间对比,差异无统计学意义（P>0.05）。以微结节为CT影像表现的血行播散性肺结核3例,见于利福平耐药肺结核、耐多药肺结核和广泛耐药肺结核,CD4⁺T淋巴细胞计数38.67（20.00,55.00）个/μl。复治耐药肺结核患者出现空洞占比约66.67%,高于初治耐药肺结核患者（42.86%）,表现为厚壁空洞,累及两肺多叶段（数目>3个）,差异无统计学意义（P>0.05）。16例复查患者中,14例（87.50%）病情好转,表现为病灶吸收;1例（6.25%）病灶无变化;1例（6.25%）表现为病灶进展,最终死亡。结论 HIV感染/AIDS患者并发不同类型耐药肺结核的影像表现相似,与患者CD4⁺T淋巴细胞水平及结核治疗史相关。CD4⁺T淋巴细胞水平低下导致影像表现不典型,易发生血行播散性肺结核;广泛耐药肺结核病变范围更广,复治患者空洞发生较高预后较差。

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

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.

Key words: Human immunodeficiency virus, Acquired immune deficiency syndrome, Drug-resistant pulmonary tuberculosis, Computed tomography, Imaging feature

中图分类号:

R512.91
R52

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.

Huang Hua, Chen Shilin, Zhou Yun, Luo Weijun, Zheng Qiuting, Deng Yingying. Clinical and imaging features of drug-resistant pulmonary tuberculosis in HIV/AIDS patients[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(4): 52-57.

参考文献

[1] 余卫业, 谭卫国, 陆普选. 耐药肺结核的分类、分型及影像学表现[J/CD].新发传染病电子杂志, 2019, 4(1):42-47.
[2] 中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南第三版(2015版)[J].中华临床感染病杂志, 2015,8(5):385-401.
[3] 中国研究型医院学会感染与炎症放射学专业委员会, 中华医学会放射学分会传染病学组, 中国科技产业化促进会数字健康专业委员会, 等. 耐药肺结核影像学诊断专家共识[J/CD]. 新发传染病电子杂志, 2023, 8(5):63-74.
[4] WORLD HEALTH ORGANIZATION.Meeting report of the WHO expert consultation on the definition of extensively drug-resistant tuberculosis, 27-29 October 2020[R]. Geneva: World Health Organization, 2021.
[5] WANG Y, CHUNG M, SKRAHIN A, et al.Radiological signs associated with pulmonary multidrug resistant tuberculosis: an analysis of published evidences[J]. Quant Imaging Med Surg, 2018, 8(2): 161-173.
[6] ES LEE, MP CHANG, MG JIN, et al.Computed tomography features of extensively drug-resistant pulmonary tuberculosis in non-HIV-infected patients[J]. J Comput Assist Tomogr,2010,34(4):559-563.
[7] FISHMAN JE, SAIS GJ, SCHWARTZ DS, et al.Radiographic findings and patterns in multidrug-resistant tuberculosis[J].J Thorac Imaging,1998,13(1):65-71.
[8] LONG R, MAYCHER B, SCALCINI A, et al.The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodefciency virus type I[J]. Chest, 1991, 99(1):123-127
[9] 方瑞,吴重重,吴坚,等. 活动性肺结核的烟花征CT表现[J]. 中华放射学杂志, 2019, 53(3):196-199.
[10] 中华医学会结核病学分会, 结核病病理学诊断专家共识编写组. 中国结核病病理学诊断专家共识[J]. 中华结核和呼吸杂志, 2017, 40(6):419-425.
[11] HATIPOGLU ON, OSMA E, MANISALI M, et al.High resolution computed tomographic findings in pulmonary tuberculosis[J]. Thorax, 1996, 51(4): 397-402.
[12] YANG F, YU H, KANTIPUDI K, et al.Differentiating between drug-sensitive and drug-resistant tuberculosis with machine learning for clinical and radiological features[J]. Quant Imaging Med Surg, 2022, 12(1): 675-687.
[13] NEL M, FRANCKLING-SMITH Z, PILLAY T, et al.Chest Imaging for Pulmonary TB-An Update[J]. Pathogens, 2022, 11(2):161.
[14] WORLD HEALTH ORGANIZATION.Meeting report of the WHO expert consultation on the definition of extensively drug-resistant tuberculosis, 27-29 October 2020[R]. Geneva: World Health Organization, 2021.
[15] 中华医学会放射学分会传染病学组, 中国医师协会放射医师分会感染影像专业委员会, 中国研究型医院学会感染与炎症放射专业委员会, 等. 获得性免疫缺陷综合征相关肺结核影像诊断标准专家共识[J]. 中华医学杂志, 2021, 101(37):2962-2967.
[16] NUNES EA, DE CAPITANI EM, COELHO E, et al.Patterns of anti-tuberculosis drug resistance among HIV-infected patients in Maputo, Mozambique, 2002-2003[J]. Int J Tuberc Lung Dis, 2005, 9(5):494-500.
[17] SULTANA ZZ, HOQUE FU, BEYENE J, et al.Correction to: HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis[J]. BMC Infectious Diseases, 2021, 21(1):1-13.