HIV/AIDS伴发神经系统病变60例临床分析

Clinical analysis on 60 cases of HIV/AIDS with nervous system complications

目的总结HIV/AIDS住院患者中伴发神经系统病变的发病率、疾病谱及临床特点。方法对2009-2011年在北京佑安医院住院治疗的HIV/AIDS伴发神经系统病变患者的临床资料进行回顾性分析,总结临床表现、诊治情况及预后。结果 620例HIV/AIDS住院患者中,伴发神经系统病变者60例(9.7%)。主要临床表现包括头痛46例(76.7%)、发热43例(71.7%)、呕吐28例(46.7%)、肢体活动障碍23例(38.3%)、脑膜刺激征20例(33.3%)、意识障碍18例(30.0%)等。一般神经系统病变主要包括脑梗死5例(8.3%),多发性神经根炎5例(8.3%),不明原因的中枢神经系统感染7例(11.7%);AIDS中枢神经系统指征性疾病40例,主要包括隐球菌性脑膜炎16例(26.7%),弓形体脑病10例(16.7%),结核性脑膜炎5例(8.3%)等。一般神经系统病变患者的病死率为0.0%,40例中枢神经系统指征性疾病患者的病死率为10.0%(4/40),8例不明原因中枢神经系统感染和占位的患者的病死率为50.0%(4/8)。结论 HIV/AIDS患者合并各种神经系统并发症比较多见,主要症状包括头痛、发热、呕吐等。在各种中枢神经系统指征性疾病中,以隐球菌性脑膜炎和弓形体脑病的发病率最高;早期诊断可以降低病死率。

Objective To analyze the incidence, disease spectrum and clinical characteristics of neurological disorders among hospitalized HIV/AIDS patients. Methods Retrospectively analyzed the clinical presentation, diagnosis, management and prognosis of HIV/AIDS inpatients complicated with neurological disorders in Beijing You＇an Hospital from 2009-2011. Results Neurological complications were observed in 60 patients（9.7%） out of 620 HIV/AIDS inpatients. Main symptoms included headache（76.7%）, fever（71.7%）, vomiting（46.7%）, movement disorder of limbs（38.3%）, positive meningeal irritation signs（33.3%） and disturbance of consciousness（30.0%）. Common diseases of neurological system included 5 cases（8.3%） of cerebral infarction, 5 cases（8.3%） of peripheral neurological disorder, 7 （11.7%） central neurological system infections of unknown origin. 40 cases（66.7%） of indicative central nervous system diseases of AIDS, mainly included 16 cases（26.7%） of cryptococcal meningitis, 10 cases（16.7%） of cerebral toxoplasmosis, 5 cases（8.3%） of tuberculosis meningitis. No one died in common diseases of neurological system, 10.0% died in indicative central nervous system diseases, and 4 died in 8 patients with unclear diagnoses. Conclusions It is common to see neurological complications among HIV/AIDS patients,which are difficult to diagnose and treat, and with a high death rate.