HIV/AIDS合并慢性肝炎肝脏声像图特征与CD4^+T淋巴细胞数相关性的研究

Study on the Correlation between Ultrasonographic Features of HIV/AIDS in Patients with Chronic Viral Hepatitis and CD4^+ T Lymphocyte Number

目的探讨HIV/AIDS合并慢性病毒性肝炎在CD4+T淋巴细胞计数不同免疫时期肝脏的超声声像图特征。方法选择2010年1月-2012年12月100例慢性病毒性肝炎患者,将50例单纯性慢性病毒性肝炎作为对照组,50例合并HIV/AIDS慢性病毒性肝炎作为观察组。观察组按CD4+T淋巴细胞计数的不同免疫时期进行超声观察肝脏声像图的改变,主要观察肝脏大小、边缘、包膜、实质回声,并将观察结果与临床化验进行对照分析。结果超声改变:观察组肝脏在不同CD4+T淋巴细胞计数的免疫时期的超声异常改变主要表现在肝脏长大,肝缘变钝,肝脏包膜增厚,肝脏实质回声细密均匀、稍粗亮欠均匀、粗亮不均匀;CD4+T细胞数改变:与对照组比较,观察组CD4+T细胞数在300/mm3时以上时肝脏超声改变差异无统计学意义(P>0.05),CD4+T细胞数在100~200/mm3时,仅肝缘变钝一项差异有统计学意义(P<0.05);CD4+T细胞数100/mm3以下时肝脏超声改变差异有统计学意义(P<0.05)。结论 HIV/AIDS合并慢性病毒性肝炎,肝脏超声异常改变随着CD4+T细胞计数下降更为明显,综合考虑肝脏超声各项指标的变化有助于临床评估HIV/AIDS合并慢性病毒性肝炎的病情发展。

Objective To investigate the ultrasonic changes of liver during various immune periods with different number of CD4^＋T lymphocytes in HIV/AIDS patients with chronic viral hepatitis. Methods The clinical data of 100 patients with chronic viral hepatitis diagnosed between January 2010 and December 2012 were selected. Among them, 50 simple chronic viral hepatitis patients were designated as the control group, and the other 50 HIV/AIDS patients with chronic viral hepatitis were regarded as the experimental group. Ultrasonographic observation was applied on patients of the experimental group according to different immune period based on the number of CD4^＋ T lymphocytes. Indexes observed included liver size, the edge of liver, capsule of liver and hepatic parenchymal echo. The cross-check analysis was employed between observed results and clinical laboratory results. Results Abnormal changes of the experimental group were shown on the ultrasound observation of liver in different CD4~ T lymphocyte count immune periods, including enlargement of the liver, slightly blunt liver margin, slightly thick capsule, dense and uniform, slightly rough and not so uniform, or rough and not uniform hepatic parenchymal echo. There was no significant difference in ultrasonic changes of liver between the two groups when the CD4^＋ T cell number was over 300/mm^3. However, the difference was significant when the CD4^＋ T cell number was below 100/mm^3. Conclusions Liver abnormalities become more obvious as CD4^＋T cell count decreases in HIV/AIDS patients with chronic viral hepatitis. Comprehensive considerations of various liver ultrasound indicators are helpful in clinical evaluation of HIV/AIDS patients with chronic viral hepatitis.