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1、艾滋病相關(guān)胸部疾病的影像診斷ImagingofthethoraxinAIDS上海復(fù)旦大學(xué)附屬公共衛(wèi)生臨床中心Shanghaiaffiliatedpublichealthcentre施裕新張志勇王桂龍shiyuxinzhangzhiyongwangguilong背景Background發(fā)病率：大多數(shù)，新AIDS>50%Morbidity:50%ofnewAIDSpresentation意義:致病率和死亡率的重要原因Meaning:importantcauseofmorbidityandmortality新特點(diǎn):1
2、.治療抗病毒和預(yù)防性抗生素Newfeature:Tharapycombinationanti-retroviraltherapyandtheuseofprophylacticantibiotics2.病原體傳統(tǒng)?(PJP),少見(jiàn)?（巨毒及鳥(niǎo)分菌?)Pathogentradition(PJP)?,lesscommon(CMVandMAC)?3.人群婦女、兒童?Populationcharacteristicswomenandchildren?背景Background4.影像:多樣,重疊Radiologicalap
3、pearances:varietyandoverlap5.影像結(jié)合臨床:Imagingbeinterpretedinconjuctionwithclinicalinformation獲得背景，并發(fā)癥，CD4+細(xì)胞數(shù)，治療緩急程度血氧分析和痰菌培養(yǎng)NatureofHIVacquisition,previousinfectionsornon-infectionscomplications,CD4+cellcount,currentdrugtherapy,andacutenessofonsetandseverityo
4、ftheillness,pulseoximetryandsputummicroscopyCD4細(xì)胞計(jì)數(shù)與肺部并發(fā)癥CD4細(xì)胞計(jì)數(shù)（×106個(gè)/L）肺部病原體(種類(lèi)、表現(xiàn))>200細(xì)菌性肺炎結(jié)核（繼發(fā)性）肺癌50－200細(xì)菌性肺炎結(jié)核（原發(fā)性）肺癌肺孢子蟲(chóng)肺炎Kaposi肉瘤淋巴瘤真菌感染弓形體病桿菌性血管瘤病<50細(xì)菌性肺炎結(jié)核（非典型）肺癌肺孢子蟲(chóng)肺炎Kaposi肉瘤淋巴瘤真菌感染弓形體病桿菌性血管瘤病鳥(niǎo)型分枝桿菌巨細(xì)胞病毒RelationshipbetweendecliningCD4+countandons
5、etofHIV-associatedpathologiesCD4+cellcount(×10-6cellsI-1)Pulmonarypathology＞200BacterialpneumoniaTB(re-infection)Lungcarcinoma50–200BacterialpneumoniaTB(primary)LungcarcinomaPCPKSLymphomaFungalinfectionsToxoplasmosisBacillaryangiomatosis＜50Bacterialpneumonia
6、TB(atypicalappearances)LungcarcinomaPCPKSLymphomaFungalinfectionsToxoplasmosisBacillaryangiomatosisMACCMVTB,Tuberculosis;PCP,Pneumocystiscariniipneumonia;KSKaposi’ssarcoma;MAC,Mycobacteriumaviumcomplex;CMV,cytomegalovirus.影像價(jià)值TheroleofCTl確定病變Confirmingsuspec
7、tedchestdiseasel鑒別診斷Differentialdiagnosisl活檢或胸腔引流Advisingonandperformingthoracicinterventionssuchasbiopsyorchestdrainagel療效檢測(cè)及隨訪MonitoringtheresponsetotherapyfollowingdiagnosisCTCT>普通胸片CTissuperiortoplainchestradiographyCT確診率不高,約50%AccuracyofCTinthediagnosis
8、ofthoraciccomplicationsofAIDSlow,about50%確定病變，胸片-/?Confirmingsuspectedchestdisease定性診斷Clarificationofabnormalitiesidentifiedonplainchestradiographs病變范圍和形態(tài)Theextentofdiseaseandthepatternofparench
