pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2018-28-2-211-216pulmo-987Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESРентгенологические проявления туберкулеза легких, сочетанного с инфекцией вирусом иммунодефицита человека, при различной степени иммуносупрессии у лиц с девиантным поведениемRadiographic features of pulmonary tuberculosis in HIV-infected patients with different severity of immunosuppression and deviant behaviorБоровицкийВ. С.BorovitskiyV. S.

к. м. н., врач-фтизиатр

Candidate of Medicine, phthisiatrician

qwertyuiop54@yandex.ruФилиал «Туберкулезная больница» Федерального казенного учреждения здравоохранения «Медсанчасть-43» Федеральной службы исполнения наказанийРоссияBranch Tuberculosis Hospital, Medical Unit No.43, Federal Penitentiary Service of Russian FederationRussian Federation201830062018282211216Copyright © Боровицкий В.С., 20182018Боровицкий В.С.Borovitskiy V.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/987

Целью исследования явилось изучение характера рентгенологических проявлений туберкулеза легких (ТЛ), сочетанного с инфекций вирусом иммунодефицита человека (ВИЧ) при различной степени иммуносупрессии у лиц с девиантным поведением, находившихся на обследовании и лечении в противотуберкулезном пенитенциарном учреждении. Материалы и методы. Проведено обсервационно-аналитическое одноцентровое сплошное ретроспективное исследование, в котором приняли участие больные ТЛ, сочетанным с ВИЧ-инфекцией (n = 257). Результаты. Поражение легких туберкулезным процессом выявлено у 94,2 % больных. При снижении уровня иммунитета отмечается увеличение внелегочных и генерализованых форм ТЛ. Наибольшее число больных отмечено в возрастных группах 20–29 и 30–39 лет. Установлено, что особенностью рентгенологической картины явилось поражение корня легкого за счет внутригрудных лимфатических узлов у больных с количеством CD4-лимфоцитов < 100 клеток в 1 мкл. Отмечено увеличение числа пациентов с милиарной диссеминацией. Заключение. Наиболее часто встречающейся клинической формой независимо от уровня CD4-лимфоцитов является инфильтративный ТЛ. При снижении количества CD4-лимфоцитов < 100 клеток в 1 мкл наиболее часто (22,0 % случаев) определяется поражение ≥ 3 долей легких, реже – поражение 1–2 сегментов (41,5 % случаев). При снижении количества CD4-лимфоцитов < 100 клеток в 1 мкл наиболее часто определяется выраженная степень инфильтрации легочной ткани (39,0 %), а умеренная инфильтрация легочной ткани от уровня снижения иммунитета не зависит. Независимо от уровня снижения иммунитета наиболее часто определяются каверны в легких ≤ 2 см (76,9–96,0 %), чаще с правосторонней локализацией (36,4–53,8 %).

The objective of this study was to investigate radiological features of pulmonary tuberculosis in HIV-infected patients with different severity of immunosuppression and deviant behavior. Methods. This was a single-center total observational retrospective study. The study involved 257 patients with pulmonary tuberculosis and NIV-infection who was treated and followed at a penitentiary tuberculosis hospital. Results. Tuberculosis-associated lung lesions were diagnosed in 94.2% of patients. Extrapulmonary and generalized tuberculosis increased with worsening immunity. Majority of patients were 20 – 29 and 30 – 39 years old. Typical radiological features included lung root lesions due to hilar lymph node enlargement in patients with CD4 lymphocytes < 100 cells/µL. CD4 lymphocytes decrease < 100 cells/µL was more likely in patients with involvement of ≥ 3 lung lobes and less likely in patients with involvement of 1 or 2 lung segments. CD4 lymphocytes decrease < 100 cells/µL was associated with prominent lung tissue infiltration (39.0%); moderate infiltration of the lung tissue did not depend on immunosuppression. Cavitation ≤ 2 cm was frequent (76.9 – 96.0%), mostly in the right lung (36.4 – 53.8%) and did not depend on immunosuppression. Conclusion. The most prevalent pulmonary tuberculosis in HIV-infected patients was infiltrative tuberculosis independently on CD4 lymphocyte number.

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The authors declare that there are no conflicts of interest present.