AIDS并发脾脏马尔尼菲篮状菌病及脾结核临床及腹部CT 表现特征分析

doi:10.19871/j.cnki.xfcrbzz.2024.04.004

摘要/Abstract

摘要： 目的探讨AIDS并发脾脏马尔尼菲篮状菌病（Talaromycosis marneffei,TSM）与AIDS并发脾结核（splenic tuberculosis,STB）的临床特征及CT表现特点,以提高对两者的诊断及鉴别诊断能力。方法回顾性分析南宁市第四人民医院2019年1月至2023年12月间确诊的22例AIDS并发脾脏TSM以及31例AIDS并发STB患者的临床及腹部CT资料,比较两组患者年龄、性别、CD4⁺T淋巴细胞计数、贫血、发热、腹胀、腹痛、皮疹等临床特征以及脾脏大小、脾脏病灶分型及强化方式、腹腔腹膜后淋巴结受累及强化方式、脾脏有无梗死等CT表现。结果脾脏TSM患者通常具有更低的CD4⁺T淋巴细胞计数且以CD4⁺T淋巴细胞计数小于20个/μl多见。与脾脏STB患者相比,脾脏TSM患者更常观察到皮疹和腹胀。两组患者性别、年龄分布比差异无统计学意义;贫血、发热、腹痛发生率差异无统计学意义。脾脏TSM患者CT表现以脓肿/肿块型多见,而STB患者CT表现以粟粒型、结节型多见。两组患者脾大、脾梗死差异无显著统计学意义。脾脏TSM通常增强扫描以无强化多见,STB以环形强化多见。两组患者均较常累及腹腔、腹膜后淋巴结,TSM相关性淋巴结肿大以均匀强化多见,淋巴结结核以环形强化为主。结论 AIDS并发脾脏TSM与STB患者的临床及CT表现具有一定特征性,CT增强扫描对两者的诊断与鉴别诊断具有较大的价值,加深对AIDS并发脾脏STM与STB患者的临床和CT特点的认识,有助于诊断和鉴别诊断。

关键词: 艾滋病, 马尔尼菲篮状菌病, 脾结核, 临床特征, 计算机断层扫描

Abstract: Objective To explore the clinical features and CT imaging characteristics of AIDS complicated by Talaromycosis marneffei (TSM) and splenic tuberculosis (STB), aiming to enhance the diagnostic and differential diagnostic capabilities of both conditions. Method A retrospective analysis was conducted on clinical and abdominal CT data of 22 patients with AIDS complicated by TSM and 31 patients with AIDS complicated by STB, diagnosed at the Fourth People's Hospital of Nanning between January 2019 and December 2023. The clinical features (age, gender, CD4⁺T lymphocyte count, anemia, fever, abdominal distension, abdominal pain, and skin rash) were compared between the two groups. CT manifestations, including spleen size, classification and enhancement patterns of splenic lesions, involvement and enhancement patterns of abdominal and retroperitoneal lymph nodes, and presence of splenic infarction, were also evaluated. Result Patients with splenic TSM typically had lower CD4⁺T lymphocyte counts, with counts below 20 cells/μl being more prevalent. Skin rash and abdominal distension were more frequent in splenic TSM patients compared to those with splenic STB. No statistically significant differences were observed in gender, age distribution, or incidence of anemia, fever, and abdominal pain between the groups. The CT imaging of splenic TSM patients predominantly revealed abscess/mass-type lesions, while STB patients more commonly presented with miliary or nodular patterns. There was no significant difference in splenomegaly and splenic infarction between the two groups. Splenic TSM typically demonstrated no enhancement on enhanced CT scans, while STB often exhibited ring enhancement. Both groups frequently showed abdominal and retroperitoneal lymphadenopathy, with TSM-related lymphadenopathy often displaying homogeneous enhancement and tuberculous lymph nodes primarily showing ring enhancement. Conclusion AIDS patients with splenic TSM and STB demonstrate distinct clinical and CT manifestations. Contrast-enhanced CT plays a crucial role in the diagnosis and differentiation of these conditions. A comprehensive understanding of the clinical and CT features of AIDS complicated by splenic TSM and STB can significantly improve diagnostic accuracy and differentiation.

Key words: Acquired immune deficiency syndrome, Talaromycosis marneffei, Splenic tuberculosis, Clinical features, Computed tomography

中图分类号:

R512.91

潘世荣, 甘东慧, 张世迁, 黄雅会, 卢亦波, 宋树林. AIDS并发脾脏马尔尼菲篮状菌病及脾结核临床及腹部CT 表现特征分析[J]. 新发传染病电子杂志, 2024, 9(4): 18-22.

Pan Shirong, Gan Donghui, Zhang Shiqian, Huang Yahui, Lu Yibo, Song Shulin. Clinical and abdominal CT characteristic analysis of AIDS complicated by Talaromycosis marneffei and splenic tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(4): 18-22.

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