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目的探讨艾滋病合并肺结核患儿的临床和影像学表现特征。方法回顾性分析确诊的38例艾滋病合并肺结核患儿的临床资料和影像学表现。结果 38例患儿中,全部为母婴传播;临床表现均有发育迟缓及不同程度营养不良,常伴发热(23例)、咳嗽(22例)、气促(9例)、腹泻(8例)、皮疹(6例)、呕吐(4例)、头痛嗜睡(3例)等症状;合并马尔尼菲青霉病7例(18.42%,7/38),肺孢子菌肺炎5例(13.16%,5/38)。影像学表现:位于两肺野25例(65.79%,25/38),上叶和(或)下叶背段6例(15.79%,6/38),右中叶1例(2.63%,1/38),一侧肺下叶基底段2例(5.26%,2/38),两侧肺下叶基底段4例(10.53%,4/38)。形态主要表现为斑片状22例(57.89%,22/38),大片状6例(15.79%,6/38),磨玻璃样4例(10.53%,4/38),结节状5例(13.16%,5/38),条索状1例(2.63%,1/38),伴空洞2例(5.26%,2/38),胸内外淋巴结肿大25例(65.79%,25/38),少量胸腔积液7例(18.42%,7/38),少量心包积液2例(5.26%,2/38)。随访中,治愈或好转27例(71.05%,27/38),其中3例曾发生免疫重建炎性综合征;未治愈5例(13.16%,5/38),死亡6例(15.79%,6/38)。结论儿童艾滋病合并肺结核临床表现多样,缺乏特异性;影像学检查对诊断本病,明确肺内病灶分布、形态、胸内淋巴结肿大及胸腔积液等具有一定价值,可为临床诊断提供重要依据。
Objective To investigate the clinical and imaging features of children with AIDS complicated with pulmonary tuberculosis. Methods Retrospective analysis of 38 cases of AIDS patients with tuberculosis complicated by clinical data and imaging findings. Results Among the 38 children, all were maternal-to-infant transmission. The clinical manifestations were both delayed growth and malnutrition, with fever (23 cases), cough (22 cases), shortness of breath (9 cases) and diarrhea ), Rash (6 cases), vomiting (4 cases) and headache and drowsiness (3 cases). The incidence of Penicillium marneffei in 7 cases (18.42%, 7/38), pneumocystis pneumonia in 5 cases , 5/38). Imaging findings: 25 cases (65.79%, 25/38) in the two lung fields, 6 cases (15.79%, 6/38) in the upper lobe and / or lower lobe and 1 case (2.63% 38). There were 2 cases (5.26%, 2/38) in the basal segment of the lower lobe on one side and 4 cases (10.53%, 4/38) in the basal segment of the lower lobe in both sides. There were 22 cases (57.89%, 22/38) in patchy form, 6 cases (15.79%, 6/38) in large patch, 4 cases (10.53%, 4/38) in ground glass, 1 case (2.63%, 1/38) with cord, 2 cases with cavity (5.26%, 2/38) and 25 cases with thoracic and extrahepatic lymph nodes (65.79%, 25/38) 38), a small amount of pleural effusion in 7 cases (18.42%, 7/38), a small amount of pericardial effusion in 2 cases (5.26%, 2/38). During the follow-up, 27 cases were cured or improved (71.05%, 27/38), of which 3 cases had immune reconstitution inflammatory syndrome; 5 cases (13.16%, 5/38) were cured and 6 cases died (15.79%, 6 / 38). Conclusion The clinical manifestations of AIDS complicated with tuberculosis in children are diverse and lack of specificity. Imaging examination is valuable in diagnosing the disease, clarifying the distribution, shape, intrasternal lymphadenectasis and pleural effusion in lung, which may provide an important basis for clinical diagnosis .