获得性免疫缺陷综合征并发肝脾结核的CT和MRI表现特征

摘要

目的 探讨获得性免疫缺陷综合征(AIDS)并发肝脾结核患者的CT和MRI表现特征,为临床诊断提供参考.方法 回顾性分析经穿刺或临床确诊为AIDS并发肝脾结核的26例患者(观察组),以及无免疫相关疾病的其他患者并发肝脾结核者41例(对照组),所有患者均行腹部CT和MR增强扫描.观察CT和MR增强扫描的表现特征,如病灶部位、范围(单发或多发)、形态、强化方式、并发其他脏器结核情况等.应用SPSS 19.0软件对两组数据进行统计学分析,计数资料的比较采用χ2检验,以P<0.05为差异有统计学意义.结果 观察组患者在肝脾病灶的分布上(34.62%,9/26)与对照组(12.20%,5/41)比较,差异有统计学意义(χ2=6.06,P=0.035).观察组粟粒型肝脾结核、粟粒-结节型肝脾结核、并发其他器官结核、淋巴结结核发生率分别为34.62%(9/26)、23.08%(6/26)、84.62%(22/26)、76.92%(20/26),均高于对照组的7.32%(3/41)、4.88%(2/41)、58.54%(24/41)、12.20%(5/41),仅脓肿型肝脾结核[19.23%(5/26)]低于对照组[43.90%(18/41)],差异均有统计学意义(χ2=8.06,P=0.005;χ2=5.01,P=0.025;χ2=5.03,P=0.025;χ2=19.60,P<0.01;χ2=4.30,P=0.038).对照组粟粒及小结节型MR扫描T2WI呈稍高信号,弥散加权成像(DWI)呈高信号,部分结节延迟强化.结论 观察组中肝脾结核病灶更易累及脾脏,并且病灶形态以粟粒型、粟粒-结节型多见,而且并发淋巴结结核者明显多于对照组.对AIDS并发肝脾结核患者CT或MRI表现特征的认识,有利于临床早期明确诊断.%Objective To study the CT/MRI findings in AIDS-associated hepato-splenic tuberculosis patients and analyze the discrepancy between patients in normal immunity, making sense in diagnose.Methods Twenty-six patients with AIDS and 41 cases in normal immunity diagnosed hepato-splenic tuberculosis through puncture or experimental treatment were collected.All of them were scanned by CT/MRI.Obverse lesions in the following aspects in CT/MRI, like location, single/multi, sharp, the enhancement patterns and involvement of other organs.The data were analyzed by SPSS 19.0 software through χ2 text and defining P<0.05 was statistically significant.Results The spleen was more easily involved in AIDS group (34.62%, 9/26) than in normal immunity groups (12.20%, 5/41), the difference was statistically significant (χ2=6.06, P=0.035).The incidence rate of pure mullet type tuberculosis, mullet-nodular type tuberculosis, involvement of other organs and lymph node tuberculosis respectively were 34.62% (9/26),23.08% (6/26),84.62% (22/26),76.92% (20/26), which were higher than that in normal groups (7.32% (3/41),4.88% (2/41),58.54% (24/41),12.20% (5/41)).Nevertheless abscess style was lower in AIDS groups (19.23% (5/26)) than the other groups (43.90% (18/41)).All above the dates were statistically significant (χ2=8.06,P=0.005;χ2=5.01,P=0.025;χ2=5.03,P=0.025;χ2=19.60,P<0.01;χ2=4.30,P=0.038).The mullet-nodular type were showing a T2WI high signal, an obviously high signal in DWI and delayed enhancement.Conclusion In AIDS-associated hepato-splenic tuberculosis patients, the spleen was more easily involved than liver and the lesions were in pure mullet type and mullet-nodular type in major.The lymph node tuberculosis is more often in AIDS groups.The study between AIDS patient and the normal immunity patients on CT/MRI making some sense in early clinical diagnosis.