艾滋病合并新型隐球菌性脑膜炎76例临床分析

Clinical analysis on 76 cases of AIDS patients with cryptococcal meningitis

目的总结艾滋病(AIDS)合并新型隐球菌性脑膜炎(CM)的临床、实验室检查特点与治疗转归。方法回顾性分析76例AIDS合并CM患者的临床资料。结果本组76例,男51例(67.1%),女25例(32.9%);中位病程30 d;头痛(97.4%)、发热(84.2%)、恶心呕吐(76.3%)是3大最常见的症状。局灶性神经功能缺损(38.2%)、精神异常(27.6%)及颈项强直(17.1%)相对少见,但出现这3种体征的患者的病死率显著高于阴性症状者(P<0.05)。49例(64.5%)患者颅内压升高,其中26例(34.2%)颅内压>330 mm H2O,其病死率高于颅内压<330 mm H2O者(P<0.05)。实验室检查CD4+T细胞计数的平均值为(55±49)个/μl。脑脊液中葡萄糖轻微降低[(2.0±1.1)mmol/L],蛋白轻微升高[(65±40)mg/dl]。脑脊液隐球菌培养阳性率为96.1%,印度墨汁染色阳性率为86.8%。头颅CT扫描异常者占34.2%,其中表现为局灶性低密度影10例,脑膜斑片强化7例,脑实质低密度影伴边缘强化2例,脑积水伴脑室扩大2例为相对典型影像学改变。本组CM的病死率为21.1%,复发率为28.9%。结论 CM是AIDS严重并发症,应早期诊断、早期治疗,以改善患者预后。

Objective To summarize the clinical features, laboratory tests and clinical outcome of patients with AIDS associated cryptococcal meningitis（CM）. Methods The clinical data of 76 cases with CM and AIDS were analyzed retrospectively. Results Of the 76 cases, 51（67.1%） were males. The median time from the onset of illness to diagnosis was 30 days. The most common symptom was headache（97.4%）, fever（84.2%）, nausea or vomiting（76.3%）. The uncommon signs were local lesions with neurofunctional deficits（38.2%）, altered mentation（27.6%） and neck stiffness（17.1%）, while there were statistically significant differences between the patients with and without the above 3 signs in the mortality（P〈0.05）. Forty-nine（64.5%） of patients had an intracranial pressure（ICP） ≥180 mm H2 O, 34.2% showed an ICP 330 mm H2 O. The mortality of the patients with ICP330 mm H2 O was higher than of the patients with ICP330 mm H2O（P〈0.05）. The average count of CD4＋T cell was（55±49）cells/μl, the level of CSF glucose was（2.0±1.1）mmol/L, the level of CSF protein was（65±40）mg/dl. The positive rate of CSF culture was 96.1%, the positive rate of India ink staining was86.8%. There was 34.2% of patients showed abnormalities in the head CT, including local lesions, meningitis, cerebritis and enlarged ventricles consistent with hydrocephalus.The total mortality was 21.1% and relapse rate was 28.9% in the AIDS with CM. Conclusion CM is a life-threatening complication in AIDS patients. Early diagnose and early treatment will.improve the prognosis.