艾滋病合并隐球菌病患者43例临床特点及影响预后的相关因素分析

An Analysis of Clinical Characteristics and Prognosis Related Risk Factors among AIDS Patients Complicated with Cryptococcosis

目的探讨艾滋病合并隐球菌病的临床特点及影响预后的相关因素。方法采集艾滋病合并隐球菌病住院患者43例的流行病学资料、临床表现、影像学检查、实验室检查、体格检查及疾病转归情况,统计分析影响预后的相关因素。结果 88.37%患者出现中枢神经系统感染,65.12%患者出现中枢神经系统合并肺部感染。经系统抗真菌治疗后总病死率为27.91%。出现昏迷患者病死率为71.43%,死亡病例平均脑脊液压力为297.8mm H2O,中枢神经系统合并肺部感染患者病死率为42.86%。死亡病例CD4+T细胞计数为(37.2±27.1)cells/μL,显著低于存活病例CD4+T细胞计数(74.0±59.4)cells/μL。未接受HAART治疗患者病死率为37.50%,死亡病例平均年龄显著高于存活病例。结论艾滋病合并隐球菌病患者易累及中枢神经系统和肺部,脑脊液压力高、昏迷、多器官受累、低CD4+T细胞计数、未接受HAART治疗、老年患者是艾滋病合并隐球菌病患者死亡的高危因素。

Objective To analysis clinical characteristics and prognosis related risk factors among AIDS patients complicated with Cryptococcosis. Methods We collect background information,clinical manifestation,iconography examination,laboratory examination,physical examination and prognosis among AIDS patients complicated with Cryptococcosis,then analyzing prognosis related risk factors. Results 88. 37% of patients complicated with central nervous system infection,65. 12% of patients complicated with lungs and central nervous system infection. The total mortality was 27. 91% after antifungal treatment systematically. Comapatients＇ mortality was 71. 43%,the average cerebrospinal fluid pressure of death cases was 297. 8 mm H2 O,mortality in patients with lung and central nervous system infection was 42. 86%. CD4＋T cell count of death cases was（37. 2 ± 27. 1）cells/μL,significantly lower than the survival cases whose CD4＋T cell count was（ 74. 0 ±59. 4） cells / μL. Patients who was not receiving HAART treatment a mortality of 37. 50%,the average age of death cases was significantly higher than the average age of survival cases. Conclusion AIDS patient complicated with cryptococcosis is easy to involve the nervous system and lungs,high cerebrospinal fluid pressure,coma and multi-organ involvement,low CD4＋T cell count,not receiving HAART treatment,the elderly patients are risk factors for death among AIDS patients complicated with cryptococcosis.