本文選題：艾滋病 + 免疫重建炎性綜合征��； 參考：《復旦大學》2014年碩士論文

【摘要】：背景和目的截至2013年9月30日,全國共報告現(xiàn)存活艾滋病病毒感染者和艾滋病病人約43.4萬例,接受抗病毒治療的患者累計約26萬例。從1996年起,廣泛應用高效抗反轉錄病毒療法(highly active antiretroviral therapy, HAART)或者是ART(antiretroviral therapy)來治療艾滋病感染患者,但是治療后的艾滋病病毒(HIV)感染或艾滋病(AIDS)患者,在免疫系統(tǒng)重建恢復(CD4細胞增加、病毒載量降低)的同時,部分病人病情出現(xiàn)反復、惡化,甚至直接引發(fā)患者死亡,通常將這種征象稱之為免疫重建炎性綜合征(immune reconstitution inflammatory syndrome, IRIS)或者免疫重建疾病(immune reconstitution disease, IRD)(后文統(tǒng)稱為IRIS)。國內已經(jīng)有不少文獻對于IRIS的發(fā)病機制、免疫學特征等問題進行探究,但是鮮有文章系統(tǒng)性的對艾滋病免疫重建患者影像學表現(xiàn)進行討論,尤其是神經(jīng)系統(tǒng)系統(tǒng)IRIS后發(fā)生的影像學改變,根據(jù)人群研究,IRIS多發(fā)生隱性感染,最常見的病原體是結核,所以本文主要對艾滋病IRIS合并結核感染患者的影像學以及一般資料進行研究,旨在探討上海地區(qū)艾滋病IRIS合并結核的高危因素、影像特點以及影像學診斷對于臨床的價值。方法收集上海市公共衛(wèi)生臨床中心2004年12月-2013年12月所有艾滋病合并結核患者,根據(jù)HIV相關IRIS研究國際網(wǎng)絡組織(International Network for the Study of HIV—associated IRIS,INSHI)的IRIS診斷標準,篩選IRIS合并結核感染患者,收集并分析中樞神經(jīng)系統(tǒng)、呼吸系統(tǒng)以及其他系統(tǒng)結核感染的影像學表現(xiàn)與一般資料,并與非IRIS的艾滋病合并結核感染患者進行對比。對征象進行統(tǒng)計分析,使用STATA10.0系統(tǒng),如P0.05,認為差異具有統(tǒng)計學意義。結果收集我院艾滋病合并IRIS并發(fā)結核感染患者51例,其中男性33例,女性18例,平均年齡為33.63±7.32歲,其中合并神經(jīng)系統(tǒng)病變14例,出現(xiàn)免疫重建時間為84.07±16.52天,合并呼吸系統(tǒng)及其他系統(tǒng)病變41例,免疫重建時間為37.92±10.67天,HAART治療前結核感染者11例,治療前CD4計數(shù)平均為80.67±95.34/ul,治療后CD4計數(shù)增高平均為406.25±149.27/ul,出現(xiàn)頭疼頭昏患者24例,憋喘、咳嗽、咳痰36例,腹痛或軟組織疼痛5例。非IRIS艾滋病合并結核患者,共收集確診病例183例,其中男性112例,女性71例,平均年齡為40.67±10.93歲,神經(jīng)系統(tǒng)、呼吸系統(tǒng)受累及分別為36例、147例,治療前CD4計數(shù)為110±120.34/ul,治療后CD4計數(shù)增高計數(shù)為327.38±110.65/ul,出現(xiàn)頭昏、頭痛68例,憋喘、咳嗽、咳痰132例。1、神經(jīng)系統(tǒng)：(1)艾滋病合并結核主要影像學表現(xiàn)：①腦膜強化；②結核瘤多發(fā)或者單發(fā)；③病變周圍水腫；④腦積水；⑤結核性腦膿腫。(2)艾滋病合并IRIS組以及非IRIS組在腦膜強化、病灶強化,占位效應等影像學征象,未見明顯具有統(tǒng)計性差異的征象(P0.05)；(3)IRIS組與基線影像學資料(發(fā)生IRIS前的影像學資料)進行對比,病變均進展,結核瘤,腦膜強化具有統(tǒng)計學差異(P0.05)：2、呼吸系統(tǒng)：(1)艾滋病主要影像學表現(xiàn)：①粟粒性肺結核；②結節(jié)、斑片灶；③實變；④樹芽征；⑤病變累及范圍以多肺葉為主；⑥淋巴結腫大、壞死或融合；⑦心包積液或胸腔積液；⑧支氣管充氣或者支氣管擴張。(2)IRIS組在粟粒性肺結核、心包積液,淋巴結腫大、內部壞死以及融合等影像學征象比非IRIS組出現(xiàn)率明顯增高(P0.05)；IRIS組不出現(xiàn)空洞及鈣化,以及包裹性胸腔積液。(3) IRIS組與基線影像學資料對比,患者病變明顯進展,粟粒性結核,縱膈淋巴結改變以及心包積液等具有統(tǒng)計學差異(P0.05)。3、其他：非呼吸系統(tǒng)及中樞神經(jīng)系統(tǒng)病變多伴隨呼吸系統(tǒng)病變出現(xiàn),這類結核無特異性影像學表現(xiàn)。結論1、艾滋病合并IRIS患者多為青壯年,男性居多,60%的患者CD4計數(shù)小于50/ul, HAART治療后,80.4%的患者CD4計數(shù)升高超過400/ul,IRIS的出現(xiàn)時間多在3個月內,神經(jīng)系統(tǒng)IRIS的出現(xiàn)平均時間為其他系統(tǒng)的2倍。2、艾滋病合并IRIS組與非IRIS組結核感染患者影像學比較：(1)中樞神經(jīng)系統(tǒng)影像學改變IRIS組與非IRIS組影像學表現(xiàn)相似；(2)在呼吸系統(tǒng)中,IRIS組呈浸潤性改變,粟粒性肺結核、心包積液、淋巴結的腫大內部壞死等比例明顯增加,艾滋病非IRIS合并肺結核可出現(xiàn)病變鈣化、空洞以及包裹性胸腔積液,而IRIS組未出現(xiàn)此征象；非呼吸系統(tǒng)及中樞神經(jīng)系統(tǒng)病變多伴隨呼吸系統(tǒng)病變出現(xiàn),這類結核無特異性影像學表現(xiàn)。3、IRIS組與基線影像學資料比較,病變均出現(xiàn)進展或出現(xiàn)新病灶,如粟粒性肺結核、胸腔及心包積液、縱膈出現(xiàn)淋巴結病變等,在HAART以及抗結核治療后,病變先進展后吸收的影像學變化,具有特異性,有助于IRIS的診斷。
[Abstract]:Background and objectives as of September 30, 2013, about 434 thousand cases of living AIDS and AIDS patients were reported, and about 260 thousand patients received antiretroviral treatment. From 1996, highly active antiretroviral therapy (HAART), or ART (antiretroviral ther), was widely used. Apy) to treat AIDS infected patients, but after the treatment of HIV (HIV) infection or AIDS (AIDS) patients, in the immune system reconstruction recovery (CD4 cells increase, viral load reduction), some patients have repeated, worsened, and even direct the death of the patient, usually called the immune reconstructive inflammatory complex. Immune reconstitution inflammatory syndrome (IRIS) or immune reconstitution disease (IRD) (immune reconstitution disease, IRD) (later referred to as IRIS). There have been a lot of literature on the pathogenesis and immunological characteristics of IRIS, but there are few articles on the imaging of AIDS immune reconstruction patients. The manifestations were discussed, especially the imaging changes of the nervous system IRIS. According to the population study, the most common pathogen of IRIS was tuberculosis. Therefore, this article mainly studied the imaging and general data of AIDS IRIS with tuberculosis infection, aimed at exploring the IRIS merger of AIDS in Shanghai area. The high risk factors, imaging features, and imaging diagnosis for the clinical value of tuberculosis. Methods collects all AIDS patients with tuberculosis in the Shanghai public health clinic in December -2013 December 2004. According to the HIV related IRIS Research International Network Organization (International Network for the Study of HIV - associated IRIS) Diagnostic criteria, screening IRIS with patients with tuberculosis infection, collecting and analyzing the imaging manifestations and general information of the central nervous system, respiratory system and other system tuberculosis infection, and comparing with non IRIS AIDS patients with tuberculosis infection. Statistical analysis of the signs, using the STATA10.0 system, such as P0.05, considered the difference. Results 51 cases of IRIS complicated with tuberculosis infection in our hospital were collected, including 33 males and 18 females, with an average age of 33.63 + 7.32 years, including 14 cases of nervous system lesions, 84.07 + 16.52 days of immune reconstruction, 41 cases of respiratory system and other systemic lesions, and 37.92 + 10.6 reconstruction time. On the 7 day, 11 cases of tuberculosis infection before HAART treatment. The average CD4 count was 80.67 + 95.34/ul before treatment, and the average CD4 count was 406.25 + 149.27/ul after treatment. There were 24 cases of headache and dizziness, 36 cases of cough, expectoration, abdominal pain and 5 cases of soft tissue pain. There were 183 cases of non IRIS AIDS combined with tuberculosis, of which the male was 112. Of them 112 men were 112. Of them 112 men were 112. For example, 71 women, the average age was 40.67 + 10.93 years old, the nervous system and respiratory system were involved in 36 cases and 147 cases respectively. The CD4 count was 110 + 120.34/ul before treatment. The increase count of CD4 count was 327.38 + 110.65/ul, dizziness, headache 68, cough, expectoration, 132.1, nervous system: (1) the main imaging of AIDS combined tuberculosis. Performance: (1) meningeal enhancement; (2) multiple or single tuberculoma; (3) edema around the lesion; (4) hydrocephalus; (5) tuberculous brain abscess. (2) the image of the IRIS group and the non IRIS group in the meningeal enhancement, the focus enhancement, the occupying effect, and so on, there was no apparent difference (P0.05); (3) the IRIS group and the baseline image Study data (before IRIS imaging data) were compared, the lesions were progressing, tuberculoma, and meningeal enhancement had statistical difference (P0.05):2, respiratory system: (1) the main imaging manifestations of AIDS: (1) miliary pulmonary tuberculosis; (2) tuberous pulmonary tuberculosis; (2) nodules, patch foci; (3) real changes; tree bud sign; (5) lesions involving multiple lobes; (6) drenching (2) the imaging signs of miliary pulmonary tuberculosis, pericardial effusion, lymph node enlargement, internal necrosis and fusion were significantly higher in IRIS group than in non IRIS group (P0.05); group IRIS did not appear cavities, calcification, and inclusions in group IRIS. Pleural effusion (3) compared with the baseline imaging data in group IRIS, the patients' lesions were progressed significantly, miliary tuberculosis, mediastinal lymph node changes and pericardial effusion were statistically different (P0.05).3, the other: non respiratory system and central nervous system lesions were associated with respiratory diseases, and the nodules had no specific imaging findings. 1, AIDS combined with IRIS patients were mostly young, male and 60% of the patients were less than 50/ul. After HAART treatment, 80.4% of patients increased the CD4 count more than 400/ul, the occurrence time of IRIS was more than 3 months, the average time of IRIS in the nervous system was 2 times.2 in other systems, and AIDS combined IRIS and non IRIS group tuberculosis infection. Imaging comparison: (1) the imaging changes of IRIS group and non IRIS group were similar in the central nervous system, and (2) in the respiratory system, the IRIS group showed invasive changes. The proportion of miliary pulmonary tuberculosis, pericardial effusion, and lymph node enlargement was significantly increased. Parcels of pleural effusion were not found in group IRIS; non respiratory system and central nervous system lesions were associated with respiratory diseases, and this kind of tuberculosis had no specific imaging findings of.3. Group IRIS and baseline imaging data showed that the lesions were progressed or emerging of new lesions, such as miliary pulmonary tuberculosis, pleural and pericardial effusion, and mediastinum. Lymph node lesions and so on, after HAART and anti tuberculosis treatment, the imaging changes of advanced lesions after the disease are specific, which is helpful for the diagnosis of IRIS.
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R512.91;R52

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相關期刊論文 前1條

1 馬倩;張志勇;盧洪洲;施裕新;;MRI對神經(jīng)系統(tǒng)免疫重建炎性綜合征的診斷價值[J];放射學實踐;2014年04期

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