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HIV/AIDS合并肝损伤患者的临床特点

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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.
Clinical characteristics of patients with HIV/AIDS and liver injury
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.

HIV/AIDSLiver injuryHepatocellular carcinomaHepatic diffuse large B-cell lymphomaDifferential diagnosisClinical characteristic

黄志忠、覃江龙、卢亦波、农兰伟、牟敏红、邵宏华

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广西南宁市第四人民医院介入科,南宁市 530023

广西南宁市第四人民医院感染科,南宁市 530023

广西南宁市第四人民医院放射科,南宁市 530023

广西南宁市第四人民医院皮肤科,南宁市 530023

广西南宁市第四人民医院病理科,南宁市 530023

广西南宁市第四人民医院内科,南宁市 530023

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HIV/AIDS 肝损伤 肝细胞癌 弥漫大B细胞淋巴瘤 鉴别诊断 临床特点

广西壮族自治区卫生健康委自筹课题广西南宁市第四人民医院院内课题

Z20211129NNSY2021003

2024

内科
广西壮族自治区医学科学情报研究所

内科

影响因子:0.905
ISSN:1673-7768
年,卷(期):2024.19(2)
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