人类免疫缺陷病毒感染与非感染者隐球菌性脑膜炎的临床特点及预后比较

Clinical characteristics and outcomes of Cryptococcus neoformans meningitis in patients with or without human immunodeficiency virus infection

目的探讨HIV感染与非感染状态下隐球菌性脑膜炎(CNM)的临床特点、治疗及预后情况。方法采用回顾性分析方法 ,收集2012年10月—2014年10月南宁市第四人民医院67例HIV阳性的CNM患者(HIV-CNM组)和22例HIV阴性CNM患者(非HIV-CNM组),应用Minitab 16统计软件分析两组患者的临床特点、治疗及预后情况。结果两组患者起病形式均表现为慢性起病,主要表现为头晕、头痛,发热等颅内高压症状和体征,其中非HIV-CNM组患者的头晕、头痛的发生率更高。两组患者相比较,脑脊液白细胞计数升高以HIV-CNM组更显著,差异有统计学意义;而脑脊液中蛋白和糖含量的变化以非HIV-CNM组较明显,差异有统计学意义。两组患者的临床治疗结果、误诊率和不良反应差异均无统计学意义。结论 HIV感染和非感染CNM患者多表现为慢性起病,头晕、头痛为其主要的起病形式,两组相比较,HIV-CNM组的脑脊液中白细胞升高较明显、非HIV-CNM组蛋白和糖变化更显著。

Objective To examine the clinical characteristics, treatment approaches and outcomes of Cryptococcus neoformans meningitis （CNM） in patients with or without human immunodeficiency virus （HIV） infection. Methods The 22 CNM patients without HIV infection treated in the Forth People＇s Hospital of Nanning during the period from October 2012 to October 2014 were compared with 67 HIV-positive CNM patients retrospectively in terms of their clinical data. The clinical features, treatment and outcomes were analyzed between the two groups by using Minitab version 16 software. Results Most CNM patients in both groups were characterized by chronic onset with the symptoms and signs of intracranial hypertension such as dizziness, headache, and fever. HIV-negative patients showed higher prevalence of dizziness and headache. The white blood cell count in cerebrospinal fluid （CSF） was significantly increased in HIV-positive CNM patients, while the change of protein and glucose levels in CSF were more significant in HIV-negative patients （P 〈 0.05）. Conclusions The CNM patients are mainly characterized by chronic onset and symptoms of intracranial hypertension including dizziness and headache whether they have HIV infection or not. The increase of white blood cell count in CSF is significantly higher in HIV-positive CNM patients. The change of protein and glucose levels in CSF are more significant in HIV-negative CNM patients.