以中枢神经系统症状为首发的HIV感染病例临床特点分析

Analysis of clinical characteristics of HIV infection starting with central nervous system symptoms lesions

目的探讨以中枢神经系统症状为首发的人类免疫缺陷病毒(HIV)感染病例的临床特点,提高临床对此类患者的诊断识别能力,防止漏诊和误诊。方法回顾性分析2011年1月-2018年12月天津市环湖医院收治住院的43例以中枢神经系统症状为首发的HIV感染病例的临床特点及其诊断转归。结果43例患者中男性41例,平均年龄为48.51岁;女性2例,平均年龄为50.10岁。神经系统症状表现:单侧肢体无力26例(60.5%),头痛头晕18例(41.9%),构音障碍16例(37.2%),单/双侧巴氏征(+)13例(30.2%),恶心呕吐10例(23.3%),发热8例(18.6%),视物模糊7例(16.3%),吞咽困难/饮水呛咳6例(14.0%),口角歪斜流涎6例(14.0%),运动及感觉障碍5例(11.6%),意识障碍2例(4.7%),颈抵抗2例(4.7%),大小便失禁2例(4.7%),昏迷2例(4.7%),反应迟钝1例(2.3%)。结论以中枢神经系统症状为首发的HIV感染病例表现复杂多样,临床上应加强HIV抗体的筛查检测,提高警惕防止漏诊误诊,贻误病情。

Objective To explore the HIV infection patients starting with CNS symptoms,improve the ability of clinical diagnosis and recognition of such patients,prevent the clinical missed diagnosis and misdiagnosis.Methods Totally 43 cases of HIV infection starting in the CNS,who admitted to Tianjin Huanhu Hospital from Jan,2011 to Dec,2018 were retrospectively studied.Results 41 of male,average age was 48.51 years.2 cases of female,average age was 50.10 years.CNS symptoms for unilateral limb weakness 26 cases(60.5%),headache and dizziness 18 cases(41.9%),dysarthria 16 cases(37.2%),single/double side Babinski sign(+)13 cases(30.2%),10 cases of nausea and vomiting(23.3%),fever 8 cases(18.6%),7 cases(16.3%)of blurred vision,difficulty swallowing water choking(14.0%),comes salivate 6 cases(14.0%),motor and sensory disorder in 5 cases(11.6%),disturbance of consciousness in 2 cases(4.7%),carotid resistance in 2 cases(4.7%),incontinence in 2 cases(4.7%),coma in 2 cases(4.7%),unresponsive in 1 case(2.3%).Conclusion The clinical manifestations of HIV infection patients starting with CNS symptoms are complex and diverse.We should be vigilant to prevent missed diagnosis and misdiagnosis.