不同颅内压的艾滋病合并隐球菌脑膜炎患者临床特征分析

Clinical Features Analysis of AIDS Combined with Cryptococcal Meningitis Patients with Different Intracranial Pressure

目的总结四川地区艾滋病(AIDS)合并隐球菌脑膜炎不同颅内高压患者的临床特征。方法收集成都市公共卫生临床医疗中心2014年1月至2017年12月住院治疗的105例AIDS并隐球菌性脑膜炎患者临床资料,按照入院时监测的颅内压分为中-重度颅高压组和非中-重度颅高压组,分析两组患者临床特点、实验室特点、影像学特点以及出院时结局。结果中-重度颅高压组中头痛、恶心呕吐、意识障碍、脑膜刺激征发生比例明显高于非中重度颅高压组,差异有统计学意义(P<0.05)。两组比较头部影像学异常比例差异无统计学意义(P>0.05),但是存在CT和MRI检查结果不一致;中-重度颅高压组中采用和未采用腰大池引流的患者死亡率差异无统计学意义(P>0.05)。结论应加强中-重度颅高压患者管理以减少住院期间病死率。建议有条件的情况下艾滋病合并隐球菌脑膜炎患者尽可能行头部MRI检查。

Objective To summarize the clinical features of AIDS and cryptococcal meningitis patients with different intracranial hypertension in Sichuan. Methods The clinical data of 105 patients with AIDS and cryptococcal meningitis who were hospitalized in Chengdu Public Health Clinical Medical Center from January 2014 to December 2017 were collected and the patients were divided into moderate-severe intracranial hypertension group and non-moderate--severe intracranial hypertension group according to the intracranial pressure monitored at admission.The clinical characteristics,laboratory characteristics,imaging features and discharge outcomes of the two groups were analyzed. Results The incidence of headache,nausea and vomiting,disturbance of consciousness and meningeal irritation in the moderate-severe intracranial hypertension group was significantly higher than that in the non-moderate-severe group( P <0.05).There was no significant difference in the proportion of head imaging abnormalities between the two groups( P >0.05),but the results of CT and MRI were inconsistent.There was no statistical difference in mortality between patients with or without lumbar drainage in moderate-severe intracranial hypertension group( P >0.05). Conclusion The management of patients with moderate-severe intracranial hypertension should be strengthened to reduce the mortality rate during hospitalization.It is recommended that patients with AIDS and cryptococcal meningitis should have a head MRI as far as possible.