获得性免疫缺陷综合征并发肝脾结核的CT和MRI表现特征

The study of AIDS-associated hepato-splenic tuberculosis in CT/MRI findings

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SPSS19．0软件对两组数据进行统计学分析，计数资料的比较采用7。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（X^2=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E19．23％（5／26）]低于对照组[43．90％（18／41）]，差异均有统计学意义（X^2=8．06，P=0．005；X^2=5．01，P=0．025；X^2=5．03，P=0．025；X^2=19．60，P〈O．01；X^2=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 foliowing 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 X^2 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 （X^2 = 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 （7.32G （3/41）,4.88G （2/41）,58. 54% （24/41）, 12. 20%（5/41））. Nevertheless abscess style was lower in AIDS groups （19.23G （5/26）） than the other groups （43.90G （18/41））. All above the dates were statistically significant （X^2 =8.06,P=0. 005;X^2 =5.01,P=0. 025;X^2=5.03,P=0. 025;X^2=19.60,P〈0. 01; X^2 =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.