AIDS合并新型隐球菌脑膜炎57例临床分析

Clinical analysis of 57 AIDS patients complicated with cryptococcal meningitis

目的了解地坛医院2009-2013年收治的艾滋病合并新型隐球菌脑膜炎患者的临床特点及治疗效果。方法采用回顾性分析方法,对57例艾滋病合并新型隐球菌脑膜炎患者的临床特点和治疗效果进行分析。数据分析应用SPSS 13软件。结果 57例艾滋病合并新型隐球菌脑膜炎患者CD+4T淋巴细胞计数的中位数为25/μL。其临床特点主要为头痛、恶心呕吐、神经功能障碍,脑膜刺激征阳性,病理征阳性,眼底检查常见视盘水肿;脑脊液检查压力显著升高,总细胞(97.7±5.86)个/μL,白细胞(19.5±4.0)个/μL,蛋白中位数40.3mg/dL,糖(2.29±0.93)mmol/L;氯化物(117.6±7.7)mmol/L。治疗效果不理想,病死率高达19.3%。结论艾滋病合并新型隐球菌脑膜炎患者免疫功能严重缺陷,脑脊液病原学阳性为确诊依据,病情重,预后差,病死率高。

Objective To explore the clinical features and therapeutic＂ effect of acquired immunodeficiency syn drome （AIDS） patients complicated with cryptococcal meningitis （CM） admitted in Beijing Ditan Hospital during the last 4 years. Methods There were 57 patients enrolled in our study. Clinical data and therapeutic effect were retro- spectively analyzed by SPSS 13. Results The median of CD4 counts in AIDS patients complicated with CM was 25 cells/μL. Headache, nausea and vomiting, dysneuria, meningeal irritation sign （＋）, pathological reflex （＋）, and papilledema were usually manifested in those patients. Cerebrospinal fluid pressure increased remarkably. Total cells in cerebrospinal fluid were 97.7±5.86/μL, with the leukocyte of 19.5±4.0/IH.. The median level of protein was 40.3 mg/dL, glucose was 2.29±0.93retool/L, and chloride was 117.6±7.7 mmol/L. Therapeutic effect was not satisfactory. The mortality was 19.3%. Conclusions AIDS Patients complicated with CM were severely immunodeficient, often with severe illness status, poor progression, and high mortality. Diagnosis was based on positive pathogen findings in cerebrospinal fluid.