二维超声及彩色多普勒超声对艾滋病感染合并腹部结核的诊断价值

Value of two-dimensional ultrasound and color Doppler ultrasound in diagnosis of AIDS complicated with abdominal tuberculosis

目的探讨二维超声及彩色多普勒超声对艾滋病感染合并腹部结核患者的诊断价值及其临床意义。方法选择武汉市皮肤病防治院初治艾滋病患者225例为研究对象,其中有26例患者合并腹部结核。所有患者均结合二维超声及彩色多普勒超声进行检查,观察分析艾滋病以及艾滋病合并腹部结核时病变形态、边界、内部后方回声、钙化灶、包膜、血流分级、阻力指数等特征。以穿刺或者手术病理检查结果为金标准,计算二维超声及彩色多普勒超声对于艾滋病及合并腹部结核病变诊断的敏感度、特异性。结果 26例艾滋病合并腹部结核患者中,15例患者合并肝脏结核,13例表现为肝脏肿大,而6例表现为肝脏局部病变,呈大小、密度均匀的高/低回声小结节,彩色多普勒超声内部与周边可见血流信号。17例患者合并脾脏结核,14例患者表现为脾脏肿大,7例表现为脾脏局部病变,呈均匀散在的低回声结节,1例病变表现为弥漫性,彩色多普勒超声没有明显的血流信号。3例患者合并肠道结核,1例合并胰腺结核,1例合并有泌尿道结核,6例患者合并腹腔积液,部分病灶无回声区域可见细小密集高回声。合并有腹部结核患者,在3~6个月抗结核治疗后,再次接受超声检查发现病变明显缩小或者消失。二维超声与彩色多普勒超声诊断艾滋病合并腹部结核的敏感度为73.07%,特异度为96.98%。结论超声可以动态分析艾滋病合并腹部结核患者病变的特点与变化,病变多呈现为无回声液化区,内少有钙化,并且肿大的淋巴结与腹腔积液以结核性为著,在临床定性上具有一定的指导意义。

OBJECTIVE To explore the value and clinical significance of two-dimensional ultrasound and color Doppler ultrasound in diagnosis of AIDS patients complicated with abdominal tuberculosis. METHODS Totally 225 AIDS patients who were initially treated in Wuhan Dermatology Prevention and Treatment Hospital were recruited as the study objects, 26 of whom were complicated with abdominal tuberculosis.All of the patients were examined by two-dimensional ultrasound and color Doppler ultrasound.The morphology, boundary, internal rear echo, calcification focus, capsule, blood flow grading and resistance index of the AIDS patients and the AIDS patients complicated with abdominal tuberculosis were observed and analyzed.The sensitivity and specificity of the two-dimensional ultrasonography and color Doppler ultrasonography in the diagnosis of AIDS complicated with abdominal tuberculosis were calculated based on the results of puncture or surgical pathology. RESULTS Among the 26 AIDS patients complicated with abdominal tuberculosis, 15 had hepatic tuberculosis, 13 had hepatomegaly, and 6 had hepatic local lesions, which showed high or low echo nodules with uniform size and density, and blood flow signals could be seen in and around the liver by color Doppler ultrasound.17 cases were complicated with splenic tuberculosis, 14 cases showed splenomegaly, 7 cases showed local pathological changes of spleen, which displayed homogeneous scattered hypoechoic nodules;1 case was diffuse, and color Doppler ultrasound did not show obvious blood flow signals.There were 3 cases complicated with intestinal tract tuberculosis, 1 case complicated with pancreatic tuberculosis, 1 case complicated with urinary tract tuberculosis and 6 cases complicated with peritoneal effusion, and some lesions showed tiny dense hyperechoic areas.The lesions of the patients who were complicated with abdominal tuberculosis were found to be significantly reduced or disappeared by ultrasound examination after the antituberculosis therapy for 3-6 months.The sensitivity of the two-dimensional ultrasound and color Doppler ultrasound was 73.07% in the diagnosis of AIIDS complicated with abdominal tuberculosis, the specificity was 96.98%. CONCLUSION Ultrasound can dynamically analyze the characteristics and changes of the lesions in the AIDS patients complicated with abdominal tuberculosis, most of the lesions show non-echogenic liquefaction areas with less calcification were characterized by the tuberculous lymph nodes and peritoneal effusion, which has certain guiding significance in clinical qualitative analysis.