ABSTRACT
Objective:
To analyze the clinical features of
acquired immunodeficiency syndrome (
AIDS)
patients complicated with peripulmonary occupational lesions.
Methods:
Fifty-five
AIDS patients with peripulmonary occupational lesions treated in Guangzhou Eighth People′s
Hospital from January 2012 to January 2019 were included, and the clinical data of
patients were retrospectively analyzed. According to the results of
lung biopsy, the
patients were divided into
Mycobacterium infection group,
fungal infection group and
tumor group. The clinical characteristics, the proportion of different CD4 +
T lymphocyte counts and
chest computed
tomography (CT) features of the three groups were compared.
Chi square test was used for comparison among the three groups, and Bonferroni
method was used to correct the test level for pairwise comparison. The significance level was 0.016 7 because of three pairwise comparisons.
Results:
Among 55
AIDS patients complicated with peripulmonary occupational lesions, pulmonary
biopsy showed 14 cases with
Mycobacterium infection, 12 cases with
fungal infection and 15 cases with
tumor lesions. Mixed
diseases were found in 11
patients, including seven cases with
Mycobacterium and
fungus coinfection, four with
tumor complicated with
fungus and (or)
Mycobacterium. Three with chronic
interstitial pneumonia. The main clinical manifestations of 55
patients were
fever, expectoration,
fatigue,
weight loss and superficial
lymph node enlargement. There were no significant differences in symptoms/signs,
white blood cell counts,
hemoglobin levels,
alanine transaminase and
creatinine among
Mycobacterium infection group,
fungal infection group and
tumor group (all P>0.05). There was significant difference in anti-retroviral
therapy (
ART) acceptance among the three groups ( χ2=15.165, P<0.01). However, the results of pairwise comparison between groups showed that there was significant difference between
fungal infection group and
tumor group ( χ2=7.514, P<0.016 7), while there was no significant difference between
Mycobacterium infection group and
tumor group,
Mycobacterium infection group and
fungal infection group ( χ2=0.255 and 5.306, respectively, both P>0.016 7). There were significant differences in clinical outcomes among the three groups ( χ2=15.119, P<0.01), and the pairwise comparison between the
Mycobacterium infection group and the
tumor group, and the
fungal infection group and the
tumor group showed significant differences ( χ2 =10.311 and 9.095, respectively, both P<0.016 7). The cases with CD4 +
T lymphocyte count ≤50/μL, 51-<200/μL and ≥200/μL in
Mycobacterium infection group were three cases, one case and 10 cases, respectively; those in
fungal infection group were 10 cases, two cases and 0 case, respectively, and those in
tumor group were one case, two cases and 12 cases, respectively. The difference was statistically significant ( χ2=21.284, P<0.01).
Chest CT showed that there was significant difference in the types of space occupying lesions among the three groups ( χ2=13.308, P=0.003), and pairwise comparison between the two groups showed that there was significant difference between the
Mycobacterium infection group and the
tumor group ( χ2=11.312, P<0.016 7), while there were no significant differences between the
Mycobacterium infection group and
fungal infection group ( χ2=0.931, P>0.016 7), and the
fungal infection group and the
tumor group ( χ2=7.053, P>0.016 7). There was significant difference among the three groups in calcification focus ( χ2=8.524, P=0.004), while there was no difference between the
Mycobacterium infection group and
fungal infection+
tumor group ( χ2=10.982, P<0.016 7).
Conclusions:
Mycobacterium infection,
fungal infection and
tumor are the main types of peripulmonary occupational lesions in
AIDS patients. The
differential diagnosis could be made by combining with
chest CT features,
ART acceptance and CD4 +
T lymphocyte level.