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目的:分析艾滋病合并周围型肺占位性病变患者的临床特征。方法:纳入2012年1月至2019年1月于广州市第八人民医院诊治的55例艾滋病合并周围型肺占位性病变患者。根据肺活组织病理检查结果分为分枝杆菌感染组、真菌感染组和肿瘤组，比较3组患者的临床特征、不同CD4 ＋T淋巴细胞计数所占比例和胸部计算机断层成像特征。3组间比较采用 χ2检验，两两比较采用Bonferroni方法校正检验水准，因为进行3次两两比较，所以检验水准取0.016 7。 结果:55例艾滋病合并周围型肺占位性病变患者中，肺活组织病理检查结果为分枝杆菌感染14例，真菌感染12例，肿瘤病变15例；11例患者为混合病变，包括分枝杆菌合并真菌感染7例，肿瘤合并真菌和(或)分枝杆菌感染4例；慢性间质性炎3例。主要临床表现为发热、咳痰、乏力、体质量下降和浅表淋巴结肿大。分枝杆菌感染组、真菌感染组和肿瘤组患者症状/体征、白细胞计数、血红蛋白、丙氨酸转氨酶、肌酐等比较差异均无统计学意义(均 P>0.05)。3组患者接受抗反转录病毒治疗差异有统计学意义( χ2＝15.165， P<0.01)，组间两两比较结果显示，真菌感染组与肿瘤组差异有统计学意义( χ2＝7.514， P<0.016 7)；分枝杆菌感染组分别与肿瘤组、真菌感染组比较，差异均无统计学意义( χ2＝0.255、5.306，均 P>0.016 7)。3组患者临床转归差异有统计学意义( χ2＝15.119， P<0.01)，组间两两比较结果显示，肿瘤组分别与分枝杆菌感染组、真菌感染组比较，差异均有统计学意义( χ2＝10.311、9.095，均 P<0.016 7)。分枝杆菌感染组CD4 ＋T淋巴细胞计数≤50/μL、51～<200/μL、≥200/μL的患者分别为3、1、10例，真菌感染组分别为10、2、0例，肿瘤组分别为1、2、12例，差异有统计学意义( χ2＝21.284， P<0.01)。胸部计算机断层成像检查显示，3组患者占位性病变类型差异有统计学意义( χ2＝13.308， P＝0.003)；组间两两比较结果显示，分枝杆菌感染组与肿瘤组差异有统计学意义( χ2＝11.312， P<0.016 7)，分枝杆菌感染组与真菌感染组差异无统计学意义( χ2＝0.931， P>0.016 7)，真菌感染组与肿瘤组差异无统计学意义( χ2＝7.053， P>0.016 7)。3组患者病灶内部钙化灶比较差异有统计学意义( χ2＝8.524， P＝0.004)；分枝杆菌感染组与真菌感染组＋肿瘤组比较差异有统计学意义( χ2＝10.982， P<0.016 7)。 结论:艾滋病合并周围型肺占位性病变以分枝杆菌感染、真菌感染和肿瘤为主，可结合胸部计算机断层成像检查的影像学特征、是否接受抗反转录病毒治疗，以及CD4 ＋T淋巴细胞水平进行鉴别诊断。

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.