AIDS合并隐球菌脑膜脑炎相关特异性实验室指标诊断的意义

Specific laboratory tests for diagnosis among AIDS patients complicated with cryptococcal meningoencephalitis

目的 评估隐球菌相关特异性实验室指标的诊断意义。方法 对2010年1月至2014年8月北京佑安医院收治的56例合并隐球菌感染的艾滋病（AIDS）病人的实验室指标进行回顾性研究。结果 56例AIDS合并隐球菌脑膜脑炎病人中,50例为实验室确诊,6例为临床诊断。CD＋4T淋巴细胞（简称CD4细胞）计数中位数为16个/mm3（四分位区间：3-56）,73.2%（41/56）病人的CD4细胞〈50个/mm3。92.9%病人有颅内高压（≥200mmH2O）,最高达570mmH2O。17例（30.4%）病人的脑脊液（CSF）蛋白〉2g/L,最高达13.7g/L,94.6%病人的CSF细胞数〈50×106/L。56例病人中墨汁染色阳性的41例（73.2%）,脑脊液和血中隐球菌抗原检测的灵敏度分别为89.3%（50人）及85.7%（48人）。用CSF隐球菌抗原作为参照,墨汁染色的灵敏度为82.0%（41/50）和特异性为100%（41/41）。治疗前后颅内高压及脑脊液蛋白显著降低（P〈0.01）。结论 实验室检查对隐球菌早期诊断治疗至关重要,建议对临床疑似合并中枢神经系统感染的所有AIDS病人广泛开展快速、方便的隐球菌乳胶凝集试验抗原早期筛查,从而实施早期诊断治疗,降低病死率。

Objective To estimate laboratory examinations for the diagnosis among patients complicated with cryptococcal meningoencephalitis. Methods Analyzed the clinical data about laboratory examination of 56 AIDS patients complicated with cryptococcal infection from Beijing Youan Hospital during 2010-2014. Results A total of 50 patients were diagnosed as cryptococcal meningoencephalitis by laboratory tests and 6 cases were diagnosed by clinical manifestations. The median CD4^＋ cell counts was 16 cells/mm^3 （IQR, interquartile range： 3-56）, 73.2% （41/ 56） patients presented with CD4 〈 50 cells/mm^3. 92.9% patients presented with intracranial hypertension（≥ 200mmH2O）, up to 570mmH2O. 17 cases presented（30.4%） with CSF protein 〉2g/L, up to 13.7g/L. 94.60% patients 94.6% with the number of CSF cells 〈50× 10^6/L. Among 56 cases, 41 （73.2%） cases was positive byink staining. The sensitivity of serum and CSF cryptococcal antigen were 89.3% （50/56） and 85.7% （48/56）, respectively. The cryptococcal antigen in CSF as a reference, the sensitivity and specificity of ink staining were 82% （41/50） and 100% （41/41）, respectively. The intracranial pressure and CSF protein decreased significantly before and after the treatment（P 〈0.01）. Conclusion To reduce motality of AIDS patients complicated with cryptococcal meningoencephalitis, it is suggested that the early detection of cryptococcal antigen should be carried out widely among the patients with suspected CNS infection among AIDS patients.