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目的评估支气管镜检查对艾滋病(AIDS)病人合并肺部疾病的应用价值。方法分析28例AIDS合并肺部疾病病人的临床表现、胸部CT、支气管镜下表现、支气管肺泡灌洗液(BALF)检验结果、经支气管肺活检病理结果。结果 28例病人的BALF结果:涂片革兰染色G+球菌阳性8例,G-杆菌阳性3例;涂片查抗酸杆菌阳性1例;涂片查真菌孢子及菌丝全阴性;人类巨细胞病毒脱氧核糖核酸(HCMV DNA)阳性14例;结核分枝杆菌脱氧核糖核酸(TB DNA)阳性5例;细菌培养铜绿假单胞菌4例,肺炎链球菌1例,烟曲霉菌2例,白色念珠菌1例。支气管肺活检组织病理:鳞癌3例,小细胞癌1例,肉芽肿性炎1例。根据支气管镜检查结果分为肺癌组(4例)、肺结核组(10例)、其他病原体感染组(14例)。经Kruskal-wallis检验,3组病人CD4+T淋巴细胞计数之间差异有统计学意义(P=0.016)。结论支气管镜检查可显著提高AIDS病人各种肺部疾病的病因诊断率,而且不受病人免疫功能缺陷的影响,具有较高的应用价值。
Objective To assess the value of bronchoscopy in the treatment of AIDS patients with pulmonary diseases. Methods The clinical manifestations, chest CT, bronchoscopic findings, bronchoalveolar lavage fluid (BALF) test results and pathological findings of bronchopulmonary biopsy in 28 AIDS patients with pulmonary diseases were analyzed. Results The results of BALF in 28 patients were positive in smear Gram-positive G-coccus in 8 cases and G-positive in 3, smear positive in acid-fast bacilli in 1 case, smear spores and hyphae in mycoplasma were all negative, human giant cells 14 were positive for HCMV DNA; 5 were positive for TB DNA; 4 were bacterial-cultured Pseudomonas aeruginosa; 1 was Streptococcus pneumoniae; 2 were Aspergillus fumigatus; Candida 1 case. Bronchial lung biopsy histopathology: squamous cell carcinoma in 3 cases, 1 case of small cell carcinoma, granulomatous inflammation in 1 case. According to bronchoscopy results were divided into lung cancer group (4 cases), tuberculosis group (10 cases), other pathogens infection group (14 cases). The Kruskal-Wallis test showed that the difference of CD4 + T lymphocyte count among the three groups was statistically significant (P = 0.016). Conclusion Bronchoscopy can significantly improve the etiological diagnosis rate of various pulmonary diseases in AIDS patients, and is not affected by the patient’s immune function defects, which is of high application value.