HIV感染与非HIV感染结核性脑膜炎临床特点比较

Comparison of Clinical Features of Tuberculous Meningitis between HIV Infection and Non HIV Infection

目的:比较分析HIV与非HIV感染结核性脑膜炎(简称结脑)的临床特点。方法:选择46例结脑患者按是否HIV感染分为HIV组24例和非HIV组22例,按是否高效抗逆转录病毒疗法(Highly active antiretroviral therapy,HARRT)治疗,HIV组分为HARRT组14例和非HARRT组10例,比较HIV组和非HIV组临床表现及脑脊液指标。Spearman法分析抗结核前CD4水平、HARRT后CD4上升幅度与抗结核预后的相关性。结果:HIV组Clarlson合并症指数高于非HIV组(t=-23.30,P<0.05);HIV组合并继发性肺结核(χ2=4.630,P=0.031)及血行播散性肺结核比例(χ2=4.354,P=0.037)高于非HIV组,合并结核性胸膜炎比例低于非HIV组(χ2=5.653,P=0.017)。两组临床症状、颅压及脑脊液生化无差别。HIV组脑脊液TB-DNA阳性率(χ2=5.956,P=0.015)及定量(t=9.163,P=0.002)低于非HIV组,抗结核前CD4水平与抗结核预后存在正相关(r=0.569,P<0.05),经HARRT治疗后CD4升高幅度与抗结核预后无关(r=0.246,P=0.247)。结论:结核性脑膜炎是艾滋病常见神经系统机会感染,结核易全身播散,检出率低,合并症多。抗结核前基线CD4水平与结脑预后相关。HARRT使免疫重建,CD4提高,但对HIV感染的结脑预后影响未明确。

Objective:To analyze and compare the clinical features of tuberculous meningitis between HIV and non HIV infection.Methods:46 cases of tuberculous meningitis patients were collected and divided into HIV group(24 case)and non-HIV group(22 case)according to whether or not infected with HIV.HIV group was divided into HARRT group(14 case)and non-HARRT group(10 case)according to whether or not HARRT.Clinical date and CSF indicators were analyzed.Spearman assay was used to analyze the correlation between the level of pre tuberculosis CD4,the increase of CD4 after HARRT and the prognosis of anti tuberculosis.Results:The complication index of Clarlson in HIV group was higher than that in non-HIV group(t=23.30,P<0.05).The ratio of HIV combined with secondary pulmonary tuberculosis(χ2=4.630,P=0.031)and blood disseminated pulmonary tuberculosis(χ2=4.354,P=0.037)were higher than those of non HIV group,and the proportion of combined tuberculous pleurisy was lower than that of non HIV group(χ2=5.653,P=0.017).There was no statistical significance difference in clinical manifestations,intracranial pressure and biochemical ncurolymph.The positive rate of ncurolymph TB-DNA(χ2=5.956,P=0.015)and quantitative(t=9.163,P=0.002)in HIV group were lower than those in non HIV group.There was a positive correlation between CD4 level before anti-tuberculosis and anti tuberculosis prognosis(r=0.569,P<0.05).The elevation of CD4 after treatment with HARRT was not associated with the prognosis of tuberculosis(r=0.246,P=0.247).Conclusion:Tuberculous meningitis is an opportunistic infection of the common nervous system of AIDS.Tuberculosis is easy to spread,the detection rate is low,and the complications is multiple.Baseline CD4 is associated with prognosis of anti-tuberculosis.HARRT makes immune reconstitution and CD4 improve,but the impact on the prognosis of tuberculous meningitis with HIV infection is not clear.