32例艾滋病神经系统病变分析

32 cases of AIDS nervous system disease analysis

目的分析艾滋病神经系统病的临床特点，以提高艾滋病的早期诊断率。方法统计32例艾滋病神经系统病变患者，分析CD4细胞计数、血清免疫学、脑脊液的变化、病原学、脑电图、头颅CT／MRI等检查；了解其诊断、治疗及转归。结果151例艾滋病人中，以神经病变系统病变患者32例，发病率21．2％。表现不同程度的发热、头痛、呕吐、抽搐、意识丧失、肢体感觉运动障碍、四肢无力、头昏、眩晕、智能下降、言语障碍、脑膜刺激征、神经功能局灶症状等临床表现。诊断为新隐球菌脑膜炎8例（25％）；进行性多灶性脑自质病6例（18．75％），弓形体脑病4例（12．5％），痴呆综合征4例（12．5％），结核性脑膜炎3例（9．37％），脑梗死3例（9．37％），面神经麻痹1例（3．13％），空泡样脊髓病1例（3．15％），多发性神经病1例（3．13％），慢性炎症性脱髓鞘多发性神经病1例（3．13％），进行性多灶性脑白质病合并新隐球菌脑膜炎2例。结论以神经系统病变的艾滋病表现多样，病情复杂，不易早期诊断，死亡率高；不易与神经系统的病毒、细菌、真菌、寄生虫感染、维生素B族缺乏、变性作鉴别，极易造成诊断延误，临床上对可疑病例应作HIV抗体检查、CD4细胞计数，应尽早诊断，及时治疗，改善预后。

Objective AIDS nervous system disease, clinical features, in order to improve early diagnosis of AIDS. Methods Statistics 32 eases of AIDS patients with neurological diseases, analysis of CD4 cell counts, serological, cerebrospinal fluid changes, etiology, EEG, head CT/MRI and other tests; understand their diagnosis, treatment and prognosis. Results 151 cases of AIDS people to neuropathy system lesions in 32 patients, the incidence rate of 21.2%. Show different degrees of fever, headache, vomiting, convulsions, loss of consciousness, limb sensory-motor disorders, weakness, dizziness, vertigo, decreased intelligence, speech impairment, meningeal irritation, focal neurological symptoms and other clinical manifestations. Diagnosis of cryptococcal meningitis for the new 8 cases （25%）; progressive multifocal leukoencephalopathy in 6 cases （18.75%）, Toxoplasma encephalopathy in 4 cases （12.5%）, dementia syndrome in 4 cases （12.5%）, tuberculous meningitis in 3 cases （9.37%）, cerebral infarction in 3 cases （9.37%）, facial palsy in 1 case （3.13%）, vacuolar myelopathy in 1 case （3.15%）, polyneuropathy in 1 case （3.13%） and chronic inflammatory demyelinating polyneumpathy in 1 case （3.13%）, progressive multifocal leukeencephalopathy incorporate new cryptococcal meningitis in 2 cases. Conclusion in AIDS nervous system disease manifestations, the disease complex and difficult early diagnosis and high mortality; difficult and nervous system viruses, bacteria, fungi, parasites, infections, vitamin B deficiency, degeneration identification, can easily cause delay in diagnosis, clinical suspected cases should be on the HIV antibody test, CD4 cell count, should be early diagnosis, timely treatment and improve prognosis.