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AIDSAIDS
2012 9 2 A. W.
40
38
2 1 1cm
CT
15 24 :
178cm, 61kg, , BP 108/60mmHg,
HR 82/min , BT 37,6 , SpO 95%(room air)
WBC 4800 /μ
RBC 3.05 10 /μ
Hb 10.2g/
Ht 30.2%
Plt 19.2 104 /μ
Neutro 69.5%
Lympho 16.7%
Mono 10.3%
Eosio 3.1%
Baso 0 .4%
Na 136 mmol/
K 4.0 mmol/
Cl 105 mmol/
Ca 8.7 mg/d
AST 18 IU/
ALT 10 IU/
LDH 245 IU/
ChE 206 IU/
ALP 301 IU/
-GT 56 IU/
T-Bil 0.4 mg/
TP 7.4 g/
Alb 2.9 g/
UN 13 mg/d
Cr 0.81 mg/
Fe 29 g/d
UIBC 200 g/d
Ferritin 855 ng/m
PT 99 %
APTT 44.9 sec
Fbg 544 mg/d
D-D 1.0μg/d
CRP 2.24 mg/
ESR 85 mm
X
CT
spare
RF 3.2 IU/m
IgG 1849 mg/d
BNP 8.7 pg/m
-D 48.5 pg/m
S-IL2R 1440 U/m
KL-6 1319 U/m
SP-D 95.3 ng/m
HIV-1 WB (+)
EIA 8.3
CD4/CD8 0.29
CD4 118/μ
(-)
(-)
room air
pH 7.431
PaO2 70.7 mmHg
PaCO2 37.2 mmHg
HCO3 24.3 mEq/
A-a gradient 32.5mmHg
SpO 95%
crackle
-D 48.5pg/m
KL-6 LDH
HIV CD4 200/μ
AIDS
ST
21
HIV-PCP non-HIV-PCPHIV-PCP Non-HIV-PCP
HIV
AIDS 40% PCP
• Wegenar
RA
•
•
•
HIV
10 20 19 40
CD4
CD4 200/μl
Sadatomo Tasaka et al.”Comparison of Cinical and Radiological Features of Pneumocystis Pneumonia Between
Malignancy Cases and Acquired Immunodeficiency Syndrome Cases”,Ann.Intern.Med. 49;273-281,2010
. AIDS . 69;112-122.2010
[ -D ]
31.1pg/m 92.3%
86.1%
[ ]
X
HIV 10~15%
HRCT 100% 83~90% HIV
[BAL]
HIV 95% PCP non-HIV 38~53%
[PCR]
HIV 72~100% non-HIV 87.2%
HIV 86~100% non-HIV 92.2%Tasaka S., et al. Chest 131;1173-1180. 2007
Hidalgo A et al.,” Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii
pneumonia and non- Pneumocystis carinii pneumonia in AIDS patients.”, Eur Radiol.13;1179-84. 2002
crazy-
paving pattern
AIDS
Jeffrey P. et al., “Pneumocystis jiroveci Pneumonia:High-Resolution CT Findings
in Patients With and Without HIV Infection”,AJR 198;555-561, 2012
,” ”, 20;281-291,2009
HIV-PCP non-HIV-PCP HRCT
Non-AIDS(n=29) AIDS(n=9) p Value
Lung nodules 9(31%) 4(44%) ns
Cystic lesions 1(3%) 5(56%) 0.015
Ground-glass opacity 25(86%) 4(44%) 0.020
Extend of finding
focal 5(17%) 1(11%) ns
extensive 3(10%) 1(11%) ns
diffuse 15(52%) 5(56%) ns
Anatomic distribution
upper lobes 9(31%) 1(11%) ns
lower lobes 5(17%) 3(33%) ns
Emilia Hardak et al.,”Radiological Features of Pneumocystis jirovecii Pneumonia in
Immunocompromised Patients with and without AIDS”,Lung 188;159-163,2010
•TNF
•
Goodman PC.” Pneumocystis carinii pneumonia.” J Thorac Imaging 6 ;16-21,1991
Marutsuka K et al.” Cavitating pneumocystis pneumonia in an autopsied case of adult T-cell
leukemia.” Int J Hematol 56;233-237,1992
3
AIDS
AIDS
AIDS