AIDS合并颈部淋巴结结核在不同CD4~+T细胞水平的超声表现特征
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摘要
目的探讨AIDS合并颈部淋巴结结核在不同CD4~+T细胞水平的超声表现特征。方法选取AIDS合并颈部淋巴结结核的患者42例,所有患者均经超声引导下粗针穿刺活检病理证实。依据穿刺前24 h内的CD4~+T细胞计数值,将42例患者分为<50个/μl组,50～<100个/μl组,100～<200个/μl组,≥200个/μl组;并在颈部病灶穿刺前24 h内行常规二维超声及超声造影检查,详细记录病灶超声声像学特征,统计分析不同CD4~+T细胞组间淋巴结的超声表现特征。结果 42例患者中,CD4~+T细胞≥200个/μl组9例,100～<200个/μl组9例,50～<100个/μl组9例,<50个/μl组15例。CD4~+T细胞≥200个/μl组患者,淋巴结最大直径主要集中在2～<3 cm,淋巴结钙化比例高于其他3组,无淋巴结融合及窦道,超声造影增强模式表现为均匀增强及不均匀增强。CD4~+T细胞100～<200个/μl组患者淋巴结直径在2～<3 cm及≥3 cm均有分布,仅1例淋巴结表现为钙化,超声造影以不均匀增强表现为主。50～<100个/μl组患者中有7例淋巴结直径> 3 cm,无钙化表现,5例有淋巴结融合,7例有窦道形成,超声造影表现为不均匀增强与环状增强。<50个/μl组患者淋巴结最大直径均> 3 cm,无淋巴结钙化,病灶内部液化、淋巴结融合、窦道形成的比例均高于其他3组,超声造影以环状增强为主。随着CD4~+T细胞减少,淋巴结直径越大,各组间差异具有统计学意义(χ~2=30.89,P <0.01);随着CD4~+T细胞减少,淋巴结融合、窦道形成的概率增大,而钙化形成减少,各组间差异有统计学意义(χ~2=62.63,P <0.01);随着CD4~+T细胞减少,超声造影增强模式逐步由均匀增强转变为环状增强,不同组间增强模式,差异有统计学意义(χ~2=23.48,P <0.01)。结论在不同CD4~+T细胞水平,AIDS合并颈部淋巴结结核的超声表现存在差异,这为临床评估AIDS合并颈部淋巴结结核的病情进展提供了影像学依据。
Objective To evaluate ultrasonographic findings of cervical lymph node tuberculosis in acquir immunodeficienoy syndrome(AIDS) patients at different CD4~+ cell levels.Methods Forty-two cases of cervical lymph node tuberculosis confirmed by ultrasound-guided core needle biopsy from AIDS patients were selected as the samples. The CD4~+T cell values of all cases were measured and divided into 4 groups based on the figures(200 cell/ul, 100～ < 200 cell/ul, 50～< 100 cell/ul and < 50 cell/ul) within 24 hours before the puncture. The patients underwent the ultrasound and contrast-enhanced ultrasonography within 24 hours before the neck lesions puncture, and the ultrasonographic features of the lesions were recorded in detail and the ultrasonographic features of lymph nodes in different CD4~+T cell groups were analyzed statistically. Results In 42 cases, 9 cases were classified into CD4~+T cells ≥ 200 cell/μl group, 9 cases in 100～ < 200 cell/μl group, 9 cases in 50～ < 100 cell/μl group, and 15 cases in < 50 cell/μl group. In the CD4~+T cells ≥ 200 cell/μl group, the largest diameters of lymph nodes mainly were 2～ < 3 cm, and the proportion of calci?cation in the lymph nodes was higher than that in other three groups. There was no lymph node fusion and sinus formation. Contrast-enhanced ultrasound enhanced mode with uniform enhancement and inhomogeneous enhancement was detected. The diameters of lymph nodes were mostly 2～ < 3 cm and ≥ 3 cm in the100～ < 200 cell/μl group. Only one lymph node showed calci?cation, while contrast-enhanced ultrasound showed heterogeneous enhancement. In the 50～ < 100 cell/μl group, 7 cases had lymph node diameter ≥3 cm, no lymph node showed calci?cation, 5 cases had lymph node fusion, 7 cases had sinus formation, and contrast-enhanced ultrasound showed inhomogeneous enhancement and circular enhancement. The maximum diameter of lymph nodes in group < 50 cell/μl was ≥ 3 cm, and there was no calci?cation of lymph nodes.The proportion of liquefaction, lymph node fusion and sinus formation in the lesion was higher than that in other three groups. Contrast-enhanced ultrasound showed mainly circular enhancement With the decrease of CD4~+T cells and the enlargement of lymph node diameter, the probability of lymph node fusion and sinus formation increased and the formation of calci?cation decreased, and there were statistical differences among different groups(χ~2=30.89, P < 0.01). Additionally, statistical differences appeared among different groups(χ~2=62.63, P < 0.01). With the decrease of CD4~+T cells, contrast-enhanced mode gradually changed from uniform enhancement to circular enhancement, and there were statistical differences among different groups(χ~2=23.48, P < 0.01). Conclusion Ultrasound manifestations of AIDS complicated with cervical lymph node tuberculosis are different at different CD4~+T cell levels, which provides an imaging basis for clinical evaluation of the progression of AIDS complicated with cervical lymph node tuberculosis.
Objective To evaluate ultrasonographic findings of cervical lymph node tuberculosis in acquir immunodeficienoy syndrome(AIDS) patients at different CD4~+ cell levels.Methods Forty-two cases of cervical lymph node tuberculosis confirmed by ultrasound-guided core needle biopsy from AIDS patients were selected as the samples. The CD4~+T cell values of all cases were measured and divided into 4 groups based on the figures(200 cell/ul, 100～ < 200 cell/ul, 50～< 100 cell/ul and < 50 cell/ul) within 24 hours before the puncture. The patients underwent the ultrasound and contrast-enhanced ultrasonography within 24 hours before the neck lesions puncture, and the ultrasonographic features of the lesions were recorded in detail and the ultrasonographic features of lymph nodes in different CD4~+T cell groups were analyzed statistically. Results In 42 cases, 9 cases were classified into CD4~+T cells ≥ 200 cell/μl group, 9 cases in 100～ < 200 cell/μl group, 9 cases in 50～ < 100 cell/μl group, and 15 cases in < 50 cell/μl group. In the CD4~+T cells ≥ 200 cell/μl group, the largest diameters of lymph nodes mainly were 2～ < 3 cm, and the proportion of calci?cation in the lymph nodes was higher than that in other three groups. There was no lymph node fusion and sinus formation. Contrast-enhanced ultrasound enhanced mode with uniform enhancement and inhomogeneous enhancement was detected. The diameters of lymph nodes were mostly 2～ < 3 cm and ≥ 3 cm in the100～ < 200 cell/μl group. Only one lymph node showed calci?cation, while contrast-enhanced ultrasound showed heterogeneous enhancement. In the 50～ < 100 cell/μl group, 7 cases had lymph node diameter ≥3 cm, no lymph node showed calci?cation, 5 cases had lymph node fusion, 7 cases had sinus formation, and contrast-enhanced ultrasound showed inhomogeneous enhancement and circular enhancement. The maximum diameter of lymph nodes in group < 50 cell/μl was ≥ 3 cm, and there was no calci?cation of lymph nodes.The proportion of liquefaction, lymph node fusion and sinus formation in the lesion was higher than that in other three groups. Contrast-enhanced ultrasound showed mainly circular enhancement With the decrease of CD4~+T cells and the enlargement of lymph node diameter, the probability of lymph node fusion and sinus formation increased and the formation of calci?cation decreased, and there were statistical differences among different groups(χ~2=30.89, P < 0.01). Additionally, statistical differences appeared among different groups(χ~2=62.63, P < 0.01). With the decrease of CD4~+T cells, contrast-enhanced mode gradually changed from uniform enhancement to circular enhancement, and there were statistical differences among different groups(χ~2=23.48, P < 0.01). Conclusion Ultrasound manifestations of AIDS complicated with cervical lymph node tuberculosis are different at different CD4~+T cell levels, which provides an imaging basis for clinical evaluation of the progression of AIDS complicated with cervical lymph node tuberculosis.
引文
1谢静,邱志峰,韩扬,等.HIV/AIDS患者外周血CD4+T细胞计数和淋巴细胞计数相关性的多中心研究[J].中华内科杂志,2015,54(2):118-121.
2于晓燕,龚君佐,任崇松,等.HIV/AIDS患者CD4+T淋巴细胞检测结果与抗病毒治疗效果[J].医学研究杂志,2016,45(11):104-107.
3王珍燕,卢洪洲,沈银忠,等.HIV/AIDS首次住院患者机会感染特点及其与CD4之间的关系[J].临床内科杂志,2009,26(3):188-190.
4豆智慧,张福杰,赵燕,等.2002-2014年中国免费艾滋病抗病毒治疗进展[J].中华流行病学杂志,2015,36(12):1345-1350.
5吴芳妮,黎友伦.GeneXpert MTB/RIF在HIV感染者中诊断结核感染效能的Meta分析[J].中国防痨杂志,2017,39(3):269-276.
6 Mohapatra PR,Janmeja AK.Tuberculous lymphadenitis[J].J Assoc Physicians India,2009,57:585-590.
7 Esmail H,Riou C,Bruyn ED,et al.The Immune Response to Mycobacterium tuberculosis in HIV-1-Coinfected Persons[J].Annu Rev Immunol,2018,36:603-638.
8 Heiden D,Saranchuk P,Keenan JD,et al.Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS[J].Lancet Infect Dis,2016,16(4):493-499.
9中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南(第三版)[J].中华传染病杂志,2015,33(10):577-593.
10刘鹏涛,邢辉,廖玲洁,等.HIV抗病毒治疗者低病毒载量耐药与CD4+T淋巴细胞计数水平间关系的研究[J].中华预防医学杂志,2018,52(3):277-281.
11 Pacheco YM,Jarrin I,Rosado I,et al.Increased risk of non-AIDS-related events in HIV subjects with persistent low CD4 counts despite cART in the CoRIS cohort[J].Antiviral Res,2015,117:69-74.
12孟艳枝,张强,孙利杰,等.颈部淋巴结结核超声表现及病理对照分析[J].湖南师范大学学报(医学版),2015,12(5):86-88.
13张更臣,李俊来,曹兵生,等.颈部淋巴结结核超声表现与病理对照研究[J].中国超声医学杂志,2013,29(10):879-882.
14陈莉贞,姚鹏,李兰娟.艾滋病合并结核分枝杆菌感染的诊断研究[J].中华临床感染病杂志,2015,8(3):269-271.
15刘新,刘保池,宋言峥,等.艾滋病合并肺外结核术后病理表现与脓毒症关系研究[J].诊断病理学杂志,2016,23(7):522-525.
16杨高怡,张莹,赵丹,等.颈部淋巴结结核超声造影分析[J].中华临床感染病杂志,2010,3(5):277-279.
2于晓燕,龚君佐,任崇松,等.HIV/AIDS患者CD4+T淋巴细胞检测结果与抗病毒治疗效果[J].医学研究杂志,2016,45(11):104-107.
3王珍燕,卢洪洲,沈银忠,等.HIV/AIDS首次住院患者机会感染特点及其与CD4之间的关系[J].临床内科杂志,2009,26(3):188-190.
4豆智慧,张福杰,赵燕,等.2002-2014年中国免费艾滋病抗病毒治疗进展[J].中华流行病学杂志,2015,36(12):1345-1350.
5吴芳妮,黎友伦.GeneXpert MTB/RIF在HIV感染者中诊断结核感染效能的Meta分析[J].中国防痨杂志,2017,39(3):269-276.
6 Mohapatra PR,Janmeja AK.Tuberculous lymphadenitis[J].J Assoc Physicians India,2009,57:585-590.
7 Esmail H,Riou C,Bruyn ED,et al.The Immune Response to Mycobacterium tuberculosis in HIV-1-Coinfected Persons[J].Annu Rev Immunol,2018,36:603-638.
8 Heiden D,Saranchuk P,Keenan JD,et al.Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS[J].Lancet Infect Dis,2016,16(4):493-499.
9中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南(第三版)[J].中华传染病杂志,2015,33(10):577-593.
10刘鹏涛,邢辉,廖玲洁,等.HIV抗病毒治疗者低病毒载量耐药与CD4+T淋巴细胞计数水平间关系的研究[J].中华预防医学杂志,2018,52(3):277-281.
11 Pacheco YM,Jarrin I,Rosado I,et al.Increased risk of non-AIDS-related events in HIV subjects with persistent low CD4 counts despite cART in the CoRIS cohort[J].Antiviral Res,2015,117:69-74.
12孟艳枝,张强,孙利杰,等.颈部淋巴结结核超声表现及病理对照分析[J].湖南师范大学学报(医学版),2015,12(5):86-88.
13张更臣,李俊来,曹兵生,等.颈部淋巴结结核超声表现与病理对照研究[J].中国超声医学杂志,2013,29(10):879-882.
14陈莉贞,姚鹏,李兰娟.艾滋病合并结核分枝杆菌感染的诊断研究[J].中华临床感染病杂志,2015,8(3):269-271.
15刘新,刘保池,宋言峥,等.艾滋病合并肺外结核术后病理表现与脓毒症关系研究[J].诊断病理学杂志,2016,23(7):522-525.
16杨高怡,张莹,赵丹,等.颈部淋巴结结核超声造影分析[J].中华临床感染病杂志,2010,3(5):277-279.