HIV/AIDS合并肝损伤患者的临床特点

Clinical characteristics of patients with HIV/AIDS and liver injury

目的总结HIV/AIDS合并肝损伤患者的临床特点。方法选取53例HIV抗体阳性合并肝损伤患者作为研究对象,根据肝脏组织病理结果分为病毒性肝炎组(n=27)、肝细胞肝癌组(n=15)和肝脏弥漫大B细胞淋巴瘤组(n=11)。比较三组患者的临床症状和腹部CT影像学特征,以及肝脏组织病理学和免疫表型。结果三组在消瘦、发热、上腹痛、浅表淋巴结肿大、丙氨酸转氨酶升高、碱性磷酸酶升高、甲胎蛋白升高方面差异均有统计学意义;三组在多发结节、单发结节、病灶不均匀强化、病灶轻度强化、病灶重度强化方面差异均有统计学意义(均P<0.05)。病毒性肝炎组镜下见肝小叶结构破坏,肝细胞肝癌组镜下见凝固性坏死组织,弥漫大B细胞淋巴瘤组镜下见肝小叶结构广泛破坏和星空现象。结论不同类型HIV/AIDS合并肝损伤患者临床症状、实验室检查结果、腹部CT影像学特征有一定差异,但其较难区分肝细胞癌和弥漫大B细胞淋巴瘤,两者鉴别诊断需借助肝脏组织病理学和免疫表型方法。

Objective To summarize the clinical characteristics of patients with HIV/AIDS and liver injury.Methods A total of 53 HIV antibody-positive patients with liver injuries were enrolled as research subjects and were divided into the viral hepatitis group(n=27),hepatocellular carcinoma group(n=15),or hepatic diffuse large B-cell lymphoma group(n=11)according to their histopathological assessments results of livers.The clinical symptoms and abdominal CT imaging characteristics,as well as histopathological assessments results of livers and immunophenotypes,were compared between the three groups.Results There were statistically significant differences in weight loss,fever,epigastric pain,and superficial lymph node enlargement,as well as increased levels of alanine transaminase,alkaline phosphatase,and alpha-fetoprotein,between the three groups;there were statistically significant differences in multiple nodules,single nodule,heterogenous enhancement of lesions,mild enhancement of lesions,and severe enhancement of lesions between the three groups(all P<0.05).Under the microscope,destructed hepatic lobules could be observed in the viral hepatitis group,coagulative necrosis tissues could be observed in the hepatocellular carcinoma group,and extensively destructed hepatic lobules and starry sky patterns could be observed in the hepatic diffuse large B-cell lymphoma group.Conclusion The clinical symptoms,laboratory tests results,and abdominal CT imaging characteristics of different types of patients with HIV/AIDS and liver injury are different,but according to which it is difficult to distinguish between hepatocellular carcinoma and hepatic diffuse large B-cell lymphoma,and the differential diagnosis of the above two requires methods like liver histopathology and immunophenotyping.