艾滋病合并新型隐球菌脑膜炎26例

Clinical analysis of 26 patients of acquired immunodeficiency syndrome complicated with cryptococcal meningitis

目的分析AIDS合并新型隐球菌脑膜炎（CM）的临床特征、预后及影响因素。方法对26例AIDS合并CM患者的诊断、实验室检查、病原学检查、治疗及预后等资料进行回顾性分析，并与AIDS合并结核性脑膜炎进行比较。统计学分析采用t检验和卡方检验。结果26例AIDS合并CM患者中22例脑脊液检出隐球菌，占84．6％，临床主要表现为发热、头痛和脑膜刺激征。24例CM患者CD4^＋T淋巴细胞均值为17．83×10^6／L，与结核性脑膜炎均值为56．09×10^6／L比较差异有统计学意义（P〈0.05）。AIDS合并CM患者全部合并其他部位感染，11例死亡。在治疗终点时，脑脊液常规结果显示预后不良组患者脑脊液细胞数为（148．9±205．9）×10^6／L，与预后良好组（27．0±25．6）×10^9／L比较差异有统计学意义（P〈0.05）。结论CIN^＋T淋巴细胞计数可作为AIDS患者合并CM和合并结核性脑膜炎鉴别诊断的重要指标。脑脊液常规可作为判断AIDS合并CM患者预后的重要指标。

Objective To investigate the clinical features, prognosis and risk factors of patients of acquired immunodeficiency syndrome （AlDS） complicated with cryptococcal meningitis （CM）. Methods Totally 26 patients of AIDS with CM who were hospitalized in the No. 8th People＇s Hospital of Guangzhou were enrolled in this study. The clinical data including diagnosis, experimental and etiological test, treatments and prognosis from all the patients were analyzed retrospectively. The results of eerebrospinal fluid routine test and CD4^＋ T lymphocyte were compared with those of AIDS patients complicated with tuberculous meningitis. Results Among the 26 patients enrolled in the study, the positive rate of cerebrospinal fluid india ink smear or Crypotococcus neoformans culture was 84.6%. The most common symptoms were fever, headache and meningeal irritation sign. The average CD4^＋ lymphocyte count was 17.83× 10^6/L, which was statistically different from that of tuberculous meningitis patients. All the patients showed concomitant multiple organ infections. The mortality rate was as high as 42.3%. At the end of therapy, the cell counts in the cerebrospinal fluid were remarkably higher in the patients with unfavorable prognosis compared to the patients with good prognosis, which was statistically different. Conclusions CD4^＋ lymphocyte count is an important marker for differentiating CM from tuberculous meningitis in AIDS patients. The results of cerebrospinal fluid routine test can predict the prognosis.