艾滋病合并细菌性肺炎的影像学及临床特点分析

摘要/Abstract

摘要： 目的探讨艾滋病合并细菌性肺炎的临床及病原学特点、胸部CT表现,为临床诊疗提供依据。方法回顾性分析105例艾滋病合并细菌性肺炎患者的临床及胸部CT资料。所有病例均符合社区获得性肺炎诊断标准,并排除合并其他肺部疾病。结果 83例患者CD4⁺T淋巴细胞<50个/μL（P<0.05）;95%的患者降钙素原（PCT）升高,而87%的患者白细胞及中性粒细胞比率（N%）正常或偏低;105例患者的痰或肺泡灌洗液标本共分离出236株病原菌,病原菌以肺炎克雷伯杆菌、铜绿假单胞菌、大肠埃希菌及金黄色葡萄球菌最为常见;61%的患者合并多菌种感染,且多为耐多药菌株,其中两种细菌感染者11例,三种细菌感染者41例,多于三种细菌感染者12例。早期的胸部CT仅表现为纹理增粗、紊乱,随后出现局灶或大片浸润影,病情严重时呈大叶性肺实变或两肺弥漫性网格状,患者病原菌的感染类型与肺部病变部位分布及胸部CT影像征象无明显相关性（P>0.05）。结论艾滋病患者合并细菌性肺炎与免疫功能状态具有相关性,CD4⁺T淋巴细胞<50个/μL的患者极易合并细菌性肺炎,与宿主年龄无明显相关性,PCT检测可协助诊断。艾滋病合并细菌性肺炎的病原菌以G^-杆菌及葡萄球菌为主,多种病原菌混合感染,耐多药菌株居多。病原学与临床表现、肺部病变部位分布及胸部CT影像征象无明显相关性,胸部CT动态观察肺内病灶有助于诊断。

关键词: 艾滋病, 细菌性肺炎, 病原学特点, 胸部CT

Abstract: Objective To explore the HIV/AIDS associated with bacterial pneumonia's clinical characteristics, etiological characteristics and chest CT imaging data,and provide guidance for clinical diagnosis and treatment.Methods The clinical data and chest CT imaging data of 105 cases of AIDS complicated with bacterial pneumonia diagnosed in Guangxi Longtan Hospital from 2014 to 2015 were retrospectively analyzed. All cases met the diagnostic criteria for community-acquired pneumonia,and other pulmonary diseases were excluded.Result sIn 83 patients, CD4⁺T was less than 50/μL（P<0.05）. Procalcitonin was elevated in 95% of patients, while leukocyte and neutrophil ratios were normal or low in 87% of patients. A total of 236 pathogenic bacteria were isolated from the sputum or alveolar lavage (BALF) specimens of 105 patients. Pathogenic bacteria samples were common in klebsiella pneumoniae, pseudomonas aeruginosa, escherichia coli and staphylococcus aureus. 61% of patients were infected with multiple bacterial species, and most of them were drug-resistant strains. There were 11 cases of two bacterial infections, 41 cases of mixed three bacterial infections, and 12 cases of patients with more than three bacterial infections. Early chest CT only showed thickening and disorder of texture, followed by focal or large infiltrating shadows. When the lesion was severe, it showed lobar pulmonary consolidation or diffuse grid-like pattern in both lungs. There was no statistically significant difference in etiology, lung lesion site distribution and chest CT images (P>0.05).Conclusion Bacterial pneumonia was associated with immune function in AIDS patients, and patients with CD4⁺T was less than 50/μL were easily associated with bacterial pneumonia, which was not significantly associated with host age. PCT examination can assist AIDS patients in the diagnosis of bacterial pneumonia. The pathogenic bacteria of AIDS complicated with bacterial pneumonia are mainly g-bacillus and staphylococcus, and a variety of pathogenic bacteria are mixed for infection, among which the majority are durg-resistant strains. There was no significant correlation between etiology and clinical manifestations, pulmonary lesion site distribution and chest CT imaging. Dynamic observation of pulmonary lesions on chest CT was helpful for diagnosis.

Key words: HIV/AIDS, Bacterial pneumonia, Etiological characteristics, Chest CT

窦艳云, 黄葵, 蓝珂, 谢璐蔓. 艾滋病合并细菌性肺炎的影像学及临床特点分析[J]. 新发传染病电子杂志, 2019, 4(1): 20-23.

DOU Yan-yun, HUANG Kui, LAN ke, XIE Lu-man. Analysis of clinical characteristics of AIDS complicated with bacterial pneumonia[J]. Electronic Journal of Emerging Infectious Diseases, 2019, 4(1): 20-23.

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