| Over the past decade, the incidence of tuberculosis (TB) presents therising trend, with the global2billion people infected with TB bacilli. Theglobal total number of patients with tuberculosis (TB) is now more than20million people, an annual increase of the number of cases at between800-9million people. According to the monitoring results of the WHO, the globalestimate of9.2million2006new cases of TB,1.7million TB deaths and4.1million new smear-positive cases. In China, more than1.3million cases ofsmear positive, is one of the countries with high TB incidence. Because ofhigh infectious tuberculosis, high disease resistance, high resistance, thecharacteristics of the high mortality rate, diagnostic difficulties, liver TBseriously threatens people’s health in China. Some scholars, about5.5/10ofthat tuberculosis combined liver TB incidence. Hepatic tuberculosis with feverrelated to digestive system diseases accounted for4.2%~5.1%. Existingvarious types of tuberculosis cases, more than50%of the liver TB,disseminated tuberculosis blood lines70~100%of secondary hepatictuberculosis.The clinical manifestation of hepatic tuberculosis is not obvious,especially in the early pathology, there may not be any symptoms. Sometimesthese symptoms may be concealed by symptoms of pulmonary tuberculosis orother system. These symptoms are also hidden in the process of thechemotherapy treatment of tuberculosis (TB). So the number of diagnosticliver TB patients is far less than the actual number of patients with hepatictuberculosis in clinical practice.In patients with hepatic tuberculosis misdiagnosis can lead to seriouscomplications such as liver damage and even liver failure. Due to the diversityof pathological changes of hepatic tuberculosis, misdiagnosis is very common,especially for multiple lesions of the liver TB, which is often misdiagnosed as malignant tumor, and missing the first time for treatment can lead to seriousconsequences. Considering the severity of hepatic tuberculosis, understandingof hepatic tuberculosis, such as the clinical features, laboratory examination aswell as imaging is very important.Objective: To explore the clinical features and imaging of hepatictuberculosis, characteristics and diagnostic methods of laboratory examination,in order to reduce the missed diagnosis and misdiagnosis rate of hepatictuberculosis, and clarify the diagnosis of liver TB.Method: Group reviewed the fourth hospital, HEBEI medical universityliver and gallbladder surgery in June1998to December1998cases surgicaltreatment for hepatic tuberculosis and data complete, a total of23cases.9cases (39.1%) of men and women in14cases (60.9%); Aged14-67, theaverage age of47.2years. Since the late find liver placeholder or jaundiceoccurred and to my family doctor, postoperative pathology confirmed forhepatic tuberculosis. Jun at the same time were selected in1998to December2012with the hospital treatment of80patients with liver cancer and60patients with liver disease as controls. In patients with preoperative ultrasound,CT and MRI examination, laboratory examination including ALT, AST, STB,γ-GT index. Using SPSS13.0statistical software for data analysis andprocessing, chi-square analysis, as do the count data, with P <0.05for thedifference has statistical significance. Adopt single factor two-two comparedto the comparative analysis of various data.Results:1The laboratory examination1.1ALTLiver tuberculosis group serum ALT indicators are normal in7cases,abnormal in16cases, its content range is10.2-670U/L. The liver diseasegroup, with serum ALT normal in57cases, abnormal in3cases, the range ofits content is7-40U/L. Group of liver cancer, with serum ALT normal in56cases, abnormal in24cases, the range of its content is15-725U/L.1.2AST Liver tuberculosis group serum AST indicators are normal in4cases,abnormal in19cases, its content range is10.2-670U/L. The serum AST innormal liver group in57cases, abnormal in3cases, the range of its content is10-32U/L. Serum AST in liver cancer group have52cases of normal,abnormality of28cases, its content range is12.4-658U/L.1.3γ-GTLiver tuberculosis group γ-GT normal in3cases, abnormal in20cases,and its range is10.2-670U. Of serum in liver disease group54cases withnormal γ-GT, abnormal in6cases, the range of its content is8-66U. SerumAST in liver cancer group have52cases of normal, abnormality of28cases,its content range is12.4-658U/L.1.4STBSTB content in serum of normal hepatic tuberculosis in5cases, abnormalin18cases, its range is5.6-97.8mmol/L. The serum STB of39cases ofnormal liver group, the abnormal in21cases, its content range is7.3to38.95mmol/L. Serum STB in liver cancer group of44cases of normal, abnormalityin36cases, its content range is9.6-94.2mmol/L.2Imaging examination2.1UltrasoundThe study of23patients with hepatic tuberculosis were ultrasound in12cases, of which only consider tuberculosis,2cases report this in2B to exceedreport typically described as solid or cystic or solid mass, border and clear, theedge is smooth, the mass single or multiple, echo can be uniform ornon-uniform, but all is given priority to with low echo. As shown in figure1.2.2CT23cases of hepatic tuberculosis patients,22patients were enhanced CTexamination, including clear consider liver tuberculosis in3cases; Considerliver malignant tumor in8cases,3cases of hepatic tuberculosis CT reporttypically described as circular low density lesions, boundary owes clear,strengthening for edge after strengthening, like a envelope structure, theinternal density without change, or multiple low density foci in the liver, the parts is bigger, the boundary is clear, its density is uneven, strengtheningvisible center after mild or moderate strengthening. As shown in figure2.2.3MRI23cases of hepatic tuberculosis patients enhanced MRI examination has10people, all are descriptive diagnosis, MRI report which representativedescribed as intrahepatic multiple class round long T1long T2signal,characterized by low signal on T1WI and Low signal on T2WI peripheralclear ring high signal, visible to the center of the mottled high signal area.Enhanced scan can be found after clear and continuous edge of the annularenhancement or separated reinforcement. As shown in figure3.Conclusion：1In patients with hepatic tuberculosis, gamma GT in serum levels are nota significant rise in liver disease and hepatocellular carcinoma group, can beused as a reference index of the diagnosis of liver TB.2In patients with hepatic tuberculosis, STB in serum levels are not asignificant rise in liver disease and hepatocellular carcinoma group, can beused as a reference index of the diagnosis of liver TB.3In the liver, liver cancer and liver disease in patients with tuberculosis,there was no significant difference of ALT and AST level, no reference valueto diagnosis of liver TB.4In patients with hepatic tuberculosis, scan CT visible circular lowdensity lesions, improved edge in CT lesions improved, seems to have amembrane structure, namely the edge "flower ring" strengthening, and thecenter "the bull’s eye" strengthening characteristic.5In patients with hepatic tuberculosis, MRI T2WI appear near the centerarea of low signal and the surrounding area of high signal, the improved edgeloop arterial can appear when improved, the portal issue or delay visiblelesions more clear ring of continuous reinforcement, as its characteristic.6In patients with hepatic tuberculosis, B ultrasonic examination arecharacteristic of intrahepatic spread in low echo, multiple small nodule with asolid and cystic change accompanied by multiple low echo. 7Imaging and laboratory examination is an effective indicator to helpclear diagnosis of liver TB, but in clinical practice should be combined withindividual differences in patients that can be used to diagnosis, and there isstill a need for some prospective studies to better guide the diagnosis ofhepatic tuberculosis. |
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