获得性免疫缺陷综合征合并颅内占位性病变患者的病理学分析

Clinicopathological features of patients with acquired immune deficiency symptom complicated with intracranial space occupying lesions

目的通过分析获得性免疫缺陷综合征(AIDS)合并颅内占位性病变患者的临床病理类型,以提高对AIDS合并颅内占位性病变的诊断水平,改善患者预后。方法回顾性分析首都医科大学附属北京地坛医院2013年5月至2017年5月神经外科手术收治的36例AIDS合并颅内占位性病变患者的CD4+T淋巴细胞计数、脑脊液检查指标、脑活体组织检查以及临床表现。分别根据患者中外周血CD4+T淋巴细胞计数和病理学类型进行分组。结果颅内占位性病变AIDS患者占同期入院患者的1.45%。临床表现主要为发热、头疼、呕吐、肢体障碍和意识障碍等。无特殊病原体感染的HIV脑病患者16例(44.4%);脑实质感染性病变患者12例(33.3%),其中结核分枝杆菌感染者6例(16.7%),真菌感染者3例(8.3%),弓形虫感染者1例(2.8%),巨细胞病毒感染者1例(2.8%),梅毒感染者1例(2.8%);发生颅内肿瘤患者8例(22.2%),其中弥漫大B淋巴细胞瘤患者4例(11.1%),Burkitt淋巴瘤患者3例(8.3%),少突胶质细胞瘤患者1例(2.8%),经治疗后,好转者27例(占75%),无变化者5例(占13.9%)和死亡4例(占11.1%)。36例患者中外周血CD4+T淋巴细胞计数<50个/μl者20例(55.6%),50~100个/μl者7例(19.4%),100~200/μl者5例(13.9%),>200个/μl者4例(11.1%)。HIV脑病与脑实质感染性病变、颅内肿瘤患者CD4+T淋巴细胞计数比较,HIV脑病患者CD4+T淋巴细胞计数低于其他两种病变,但差异无统计学意义(F=0.4、P=0.31,F=0.17、P=0.26)。结论 AIDS合并颅内占位性病变病理类型复杂,HIV脑病发病率最高,其次是机会性感染和肿瘤。当患者CD4+T淋巴细胞计数<200个/μl时,应尽早行脑活体组织学检查以明确诊断,改善患者预后,提高治愈率。

Objective To investigate the clinical and pathological features of intracranial space occupying lesions in patients with acquired immune deficiency symptom（AIDS）, and to improve the diagnosis and prognosis of AIDS patients with intracranial space occupying lesions. Methods The clinical manifestations, CD4＋ T cell counts, cerebrospinal fluid examination and brain biopsy of AIDS patients complicated with intracranial space occupying lesions in Beijing Ditan Hospital, Capital Medical University from May 2013 to May 2017 were analyzed, retrospectively. The patients were divided into different groups according to number of CD4＋ T lymphocytes in peripheral blood and different pathological types. Results Patients with intracranial space occupying lesions accounted for 1.45% of the inpatients treated in the same period. The main clinical manifestations were fever, headache, vomiting, physical impairment（limb dysfunction） and conscious disturbance, etc. There were 16（44.4%） patients with HIV encephalopathy, 12（33.3%） patients with central nervous system infection, among the 12 patients, 6（16.7%） cases with tuberculosis infection, 3（8.3%） cases with fungus infection, 1（2.8%） case with toxoplasma, 1（2.8%） case with cytomegalovirus, 1（2.8%） case with neurosyphilis, the other 8 patients with brain tumors, 4 patients were diffuse large B cell lymphoma, 3 patients were Burkitt lymphoma, one patient was oligodendroglioma. After treatment, 27（75%） patients recovered completely or improved partially, 5（13.9%） patients had no improvement and 4（11.1%） patients died. There were 20 cases with CD4＋ T cell counts lower were 50 cells/μl, 7 cases wer 50-100 cells/μl, 5 cases were 100-200 cells/μl, and 4 cases with CD4＋ T cell counts higher than 200 cells/μl. Counts of CD4＋ T cell in HIV encephalopathy were lower than opportunistic infection and tumor, but with no significant difference（F = 0.4, P = 0.31; F = 0.17, P = 0.26）. Conclusions The pathological features of intracranial space occupying lesions in patients with AIDS were complicated, the incidence rate of HIV encephalopathy was the highest among intracranial space occupying lesions in patients with AIDS, complicated with opportunistic infection and tumor. For patients with AIDS, especially those whose CD4＋ T lymphocyte counts were lower than 200 cells/μl, it was crucial to make definite diagnosis as early as possible by brain biopsy to improve the prognosis and curative rate.