目的分析HIV感染合并肺结核患者外周血CD4+T淋巴细胞计数与其胸部影像特征的相关性。方法选取220例经Western blot确诊为HIV感染并合并肺结核患者,抽取外周血进行CD4淋巴细胞计数,同时行正位X胸片或CT检查及PPD实验。结果 220例患者中CD4细胞计数<200者占30%,PPD阳性反应仅2例患者阳性;200~500者占49%,PPD阳性率为28.7%;>500者占21%,PPD阳性率为80.4%。胸部影像检查显示当CD4细胞数>500时,肺部病变与普通患者相似,空洞、钙化灶等多见;CD4细胞数在200~500时渗出性实变较多,52%的患者可出现纤维化病灶、空洞等典型症像;CD4细胞数<200时,以弥漫性的渗出性病变为主。结论 HIV感染合并肺结核患者随着机体免疫系统受损,影像表现以渗出性病变为主,有必要与肺部其他病变相鉴别。 Objective To analyze the correlation between the CD4 + T lymphocyte count in peripheral blood of HIV-infected patients with pulmonary tuberculosis and its imaging features of the chest. Methods Totally 220 cases of HIV-infected patients with pulmonary tuberculosis were detected by Western blot. Peripheral blood was collected for CD4 lymphocyte count, positive X-ray, CT and PPD. Results Among 220 patients, the number of CD4 cells was less than 200 in 30% of cases, only 2 cases were positive in PPD test, 49% were in 200 ~ 500 cases, the positive rate was 28.7% in PPD group and 21% in> 500 cases. The positive rate of PPD was 80.4%. Chest imaging showed that when the number of CD4 cells was more than 500, lung lesions were similar to those in normal patients. Cavity and calcification were more common. Exudation of CD4 cells at 200-500 showed more consolidation and 52% of patients appeared Fibrosis lesions, voids and other typical symptoms; CD4 cell count <200, the main diffuse exudative lesions. Conclusion With HIV infection and pulmonary tuberculosis patients with the immune system damage, the performance of the image to exudative lesions, it is necessary to differentiate and other pulmonary lesions.