AIDS合并马尔尼菲篮状菌病患者胸部CT表现与CD4+T淋巴细胞计数的关系

doi:10.19871/j.cnki.xfcrbzz.2026.01.009

摘要/Abstract

摘要： 目的分析AIDS合并马尔尼菲篮状菌病（Talaromycosis,TSM）患者的胸部CT表现、肺部病变分布及病变严重程度与CD4⁺T淋巴细胞计数的关系,探讨其影像学特点与免疫状态的相关性。方法回顾性分析上海市公共卫生临床中心2015年1月至2024年12月收治的122例AIDS合并TSM患者的临床资料、胸部CT表现和CD4⁺T淋巴细胞计数。分析CT影像表现、肺部病变分布特征与CD4⁺T淋巴细胞计数的关系以及肺部病变累及的肺段数、肺部病变的CT评分与CD4⁺T淋巴细胞计数的相关性。结果 TSM患者的胸部CT表现具有多样性,主要为粟粒结节、结节、磨玻璃影或斑片影、纵隔淋巴结肿大。根据CT表现进行分组比较,粟粒结节组与无粟粒结节组、纵隔淋巴结肿大组与无纵隔淋巴结肿大组、肺部有病变组与肺部无病变组,CD4⁺T淋巴细胞计数的差异无统计学意义（P>0.05）。根据肺部病变分布情况进行分组比较,肺部病变两肺分布组与非两肺分布组、肺部病变弥漫性分布组与非弥漫性分布组,CD4⁺T淋巴细胞计数的差异无统计学意义（P>0.05）。肺部病变累及的肺段数、肺部病变的CT评分与CD4⁺T淋巴细胞计数无显著的相关性（P>0.05）。结论 AIDS合并TM感染患者肺部CT表现（包括病变形态、分布范围）及其严重程度均与CD4⁺T淋巴细胞计数无显著相关性。结果提示,TM感染所致的肺部影像学特征可能独立于宿主免疫抑制程度,这为进一步理解该疾病的病理机制提供了新的视角。

关键词: 获得性免疫缺陷综合征, 马尔尼菲篮状菌, CD4⁺T淋巴细胞, 体层摄影术

Abstract: Objective To explore the relationship between the count of CD4⁺T lymphocyte and the chest CT features including manifestation, distributions of pulmonary lesion, as well as the severity of pulmonary lesion in AIDS patients with Talaromycosis (TSM). Method A retrospective analysis was performed on the clinical data, chest CT findings and CD4⁺T lymphocyte counts of 122 patients with AIDS complicated by TSM who were admitted to Shanghai Public Health Clinical Center from January 2015 to December 2024. The relationships between CT imaging manifestations/distribution characteristics of pulmonary lesions and CD4⁺T lymphocyte counts were investigated. The correlations between the number of affected pulmonary segments/CT severity scores and CD4⁺T lymphocyte counts were analyzed. Result The chest CT manifestations of AIDS patients with TSM were diverse, mainly including miliary nodule, nodule, ground-glass opacity or patchy shadow, and mediastinal lymphadenopathy. There were no significant differences in CD4⁺T lymphocyte count among groups with different chest CT manifestations (P>0.05), including between groups with miliary nodule and those without, groups with mediastinal lymphadenopathy and those without, and groups with pulmonary lesion and those without. There were no significant differences in CD4⁺T lymphocyte count among groups with different distributions of pulmonary lesion (P>0.05), including between groups with bilateral distribution and non-bilateral distribution, and between groups with diffuse distribution and non-diffuse distribution. The number of lung segment involved by pulmonary lesion and the CT score of pulmonary lesion showed no significant correlation with CD4⁺T lymphocyte count (P>0.05). Conclusion This study demonstrates that the pulmonary CT manifestations (including lesion morphology and distribution) and their severity in AIDS patients with Talaromyces marneffei infection show no significant correlation with CD4⁺T lymphocyte counts. These findings suggest that the imaging characteristics of Talaromyces marneffei infection may be independent of the degree of host immunosuppression, providing a new perspective for understanding the pathogenesis of this disease.

Key words: Acquired immune deficiency syndrome, Talaromyces marneffei, CD4⁺T lymphocyte, Tomography

中图分类号:

石秀东, 丁晨寒, 杨影, 宋朋睿, 施裕新. AIDS合并马尔尼菲篮状菌病患者胸部CT表现与CD4⁺T淋巴细胞计数的关系[J]. 新发传染病电子杂志, 2026, 11(1): 55-59.

Shi Xiudong, Ding Chenhan, Yang Ying, Song Pengrui, Shi Yuxin. The correlation between chest CT manifestations and CD4⁺T lymphocyte count in AIDS patients with Talaromycosis[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(1): 55-59.

参考文献

[1] 石秀东, 黄诗雯, 詹艺, 等. AIDS合并马尔尼菲青霉菌感染的胸部CT表现[J]. 放射学实践, 2019,34(2): 143-146.
[2] CRIBBS SK, CROTHERS K, MORRIS A.Pathogenesis of HIV-Related Lung Disease: Immunity, Infection, and Inflammation[J]. Physiol Rev, 2020, 100(2): 603-632.
[3] 何小庆, 刘敏, 陈耀凯. 常见艾滋病相关机会性感染研究进展[J/CD]. 新发传染病电子杂志, 2025, 10(2): 81-88.
[4] 韩静, 蒋忠胜, 王刚, 等. 广西人类免疫缺陷病毒感染者/艾滋病患者合并马尔尼菲篮状菌感染的特征及Mp1p抗原快速筛检的研究[J]. 微生物与感染, 2021, 16(1): 19-25.
[5] SATI H, ALASTRUEY-IZQUIERDO A, PERFECT J, et al.HIV and fungal priority pathogens[J]. Lancet HIV, 2023, 10(11): e750-e754.
[6] 李宏军, 张玉忠, 程敬亮. 艾滋病合并肺结核的CT表现多样性与CD4+T淋巴细胞计数的关系[J]. 放射学实践, 2009, 24(9): 959-963.
[7] 杜艳妮, 闫铄, 张紫欣, 等. 艾滋病合并肺孢子菌肺炎CT影像与CD4+T淋巴细胞及血浆HIV病毒载量相关性分析[J]. 实用放射学杂志, 2019, 35(2): 200-203.
[8] 李由, 彭道杨, 刘金贵, 等. 艾滋病合并耶氏肺孢子菌肺炎的CT表现分型与CD4+T淋巴细胞的相关性研究[J]. 医学影像学杂志, 2023, 33(3): 426-430.
[9] 任美吉, 李莉, 赵晶, 等. AIDS合并播散型马尔尼菲青霉菌感染的胸腹部CT表现[J/CD]. 新发传染病电子杂志, 2017, 2(4): 214-217.
[10] SHI X, YAN Q, ZHAN Y, et al.Effect of combination antiretroviral therapy on the clinical manifestations, radiological characteristics, and disease severity of HIV-associated Talaromyces marneffei infection[J]. Int J Std AIDS, 2020, 31(8): 747-752.
[11] 李逸攀, 宋璐, 史延斌, 等. 艾滋病合并马尔尼菲蓝状菌感染患者胸部CT特征分析[J/CD]. 新发传染病电子杂志, 2023, 8(1): 35-38.
[12] 郑祎, 王辉. 艾滋病合并马尔尼菲篮状菌感染的诊治临床研究进展[J/CD]. 新发传染病电子杂志, 2021, 6(2): 151-154.
[13] 田雅. HIV/AIDS患者肺部菌群特征研究[D]. 北京:中国科学院大学, 2019.
[14] 杨振铭, 黄捷, 陈香梅, 等. 马尔尼菲篮状菌病合并其他机会性感染的临床特征研究进展[J]. 中华结核和呼吸杂志, 2023, 46(5): 503-506.
[15] 艾滋病合并马尔尼菲篮状菌病诊疗专家共识(2024年更新版)[J]. 中国艾滋病性病, 2024, 30(6): 563-572.
[16] FENG F, JIANG Y, YUAN M, et al.Association of radiologic findings with mortality in patients with avian influenza H7N9 pneumonia[J]. PLoS One, 2014,9(4): e93885.
[17] WU X, ZHONG Y, LI Z, et al.Clinical and chest CT manifestations of Talaromycosis marneffei: a retrospective study comparing anti-IFN-gamma autoantibodies-positive and HIV-positive cases[J]. BMC Infect Dis, 2024, 24(1): 1357.
[18] 刘宇轩, 韦吴迪, 包秀丽, 等. 基于转录组与代谢组联合分析马尔尼菲篮状菌毒力蛋白Mp1p对巨噬细胞的影响[J]. 中国热带医学, 2024, 24(3): 265-270.
[19] 唐艳萍, 张建全, 钟小宁, 等. 马尔尼菲青霉菌对树突状细胞分化成熟及树突状细胞诱导CD4+T淋巴细胞向Th17/Treg分化平衡的影响[J]. 广西医科大学学报, 2017, 34(5): 667-671.