人类免疫缺陷病毒感染合并结核性脑膜炎患者的临床特征及预后

Clinical characteristics and prognosis of human immunodeficiency virus infected patients with tuberculous meningitis

目的了解HIV感染对于结核性脑膜炎（tuberculous meningitis，TBM）临床特征及短期预后的影响。方法回顾性分析2015年1月至2015年12月重庆市公共卫生医疗救治中心收治的151例TBM患者的临床资料。其中，合并HIV感染者61例（HIV/TBM组），未合并HIV感染者90例（TBM组）。比较两组患者的临床表现、是否合并肺结核、脑脊液检查结果、CD4＋ T淋巴细胞计数及其临床转归等。统计学处理采用卡方检验、t检验和非参检验。结果HIV/TBM组患者出现发热、头痛、呕吐、脑膜刺激征等症状分别为49例（80.3%）、55例（90.2%）、29例（47.5%）和5例（8.2%），TBM组患者分别为80例（88.9%）、80例（88.9%）、43例（47.8%）和16例（17.8%），两组比较差异均无统计学意义（χ2值分别为2.141、0.062、0.001和2.787，均P〉0.05）。HIV/TBM组患者意识改变、盗汗和合并肺结核的发生例数分别为21例（34.4%）、19例（31.1%）和45例（73.8%）, TBM组患者分别为15例（16.7%）、54例（60.0%）和88例（97.8%），两组比较差异均有统计学意义（χ2值分别为6.316、12.120和19.958，均P〈0.05）。TBM组患者脑脊液压力均值为（263.6±123.7） mmH2O（1 mmH2O＝0.009 8 kPa），高于HIV/TBM组的（218.4±112.4） mmH2O，差异有统计学意义（t＝－2.240，P〈0.05）。HIV/TBM组患者CD4＋ T淋巴细胞计数为62（1～540）个/μL，TBM组为291（16～1 689）个/μL，差异有统计学意义（Z＝－7.994，P〈0.01）。脑脊液常规和生物化学指标、头颅影像学表现及住院治疗结果两组比较，差异均无统计学意义（均P〉0.05）。结论HIV感染对TBM患者的临床表现有明显影响，而对脑脊液指标、头颅影像学检查结果和短期预后无明显影响。

ObjectiveTo investigate the impact of human immunodeficiency virus（HIV） infection on clinical characteristics and short-term outcome of tuberculous meningitis （TBM）.MethodsOne hundred and fifty-one cases of TBM patients were retrospectively collected from Chongqing Public Health Medical Center between January 2015 and December 2015. Among them, 61 were infected with HIV （HIV/TBM group） and 90 were without HIV infection （TBM group）. Clinical manifestations, whether complicated by pulmonary tuberculosis, cerebrospinal fluid parameters and CD4＋ T lymphocyte counts and their clinical outcomes were compared. Chi square test, t test and non-parameter test were used.ResultsThe incidences of fever, headache, vomiting and meningeal irritation sign in HIV/TBM group were 80.3% （49）, 90.2% （55）, 47.5% （29） and 8.2% （5）, respectively, and those in TBM group were 88.9% （80）, 88.9% （80）, 47.8% （43） and 17.8% （16）, all of which showed no significant differences （χ2=2.141, 0.062, 0.001 and 2.787, respectively, all P〉0.05）. HIV-infected patients had higher percentage of altered consciousness （34.4% vs 16.7%, χ2=6.316, P〈0.05）, whereas patients without HIV infection had higher percentages of night sweating and pulmonary tuberculosis than those with HIV infection （60.0% vs 31.1%, χ2=12.120; 97.8% vs 73.8%, χ2= 19.958, both P〈0.05）. The mean value of cerebrospinal pressures in patients with HIV infection was 218.4 mmH2O （1 mmH2O=0.009 8 kPa）, which was significantly lower than that of patients without HIV infection （263.6 mmH2O） （t=-2.240, P〈0.05）. The median CD4＋ T cell counts in HIV/TBM group was 62 （1—540） cells/μL, while that in TBM group was 291 （16—1 689） cells/μL, with significant difference （Z=-7.994, P〈0.01）. There was no statistical difference in CSF parameters, imaging findings and in-hospital mortality between two groups （all P〉0.05）.ConclusionsHIV-infected TBM patients are more likely to have altered consciousness, and less likely to have high CSF pressure and pulmonary tuberculosis. Patients with HIV/TBM coinfection have comparable CSF parameters, head imaging findings and short-term outcomes compared with TBM patients without HIV infection.