重庆地区AIDS患者中枢神经系统感染病原学特点及脑脊液相关指标变化分析

Etiological characteristics and change of cerebrospinal fluid related measurements in AIDS patients with central nervous system infections in Chongqing

目的分析重庆地区AIDS患者中枢神经系统(central nervous system,CNS)感染病原菌分布、药敏结果及不同病原菌脑脊液相关指标结果,为AIDS患者CNS感染的病原学诊断和合理使用抗菌药物提供依据。方法将CNS感染的AIDS患者173例分为真菌组、革兰阳性杆菌组、革兰阳性球菌组、革兰阴性杆菌组,同一时期非CNS感染的AIDS患者198例为对照组。采集患者脑脊液和血液进行培养,分析其病原菌构成及耐药性,同时进行脑脊液生化检测并进行比较分析。结果CNS感染的AIDS患者脑脊液共分离出病原菌173株,其中真菌101株(58.38%),革兰阳性杆菌39株(22.54%),革兰阳性球菌24株(13.87%),革兰阴性杆菌9株(5.20%)。非CNS感染AIDS患者血液分离病原菌共198株,其中真菌107株(54.04%),革兰阳性球菌65株(32.83%),革兰阴性杆菌26株(13.13%)。新型隐球菌对唑类抗真菌药物(除氟康唑外)最小抑菌浓度(minimum inhibitory concentration,MIC)均≤1μg/ml,氟康唑≤8μg/ml,两性霉素B MIC≤4μg/ml及氟胞嘧啶MIC≤32μg/ml。结核分枝杆菌利福平耐药率7.69%。CNS感染和非CNS感染患者分离的凝固酶阴性葡萄球菌药敏结果比较一致,金黄色葡萄球菌、肠杆菌科细菌、不动杆菌抗生素结果差异比较大。与对照组相比,真菌组、革兰阳性杆菌组、革兰阳性球菌组和革兰阴性杆菌组脑脊液蛋白水平升高,氯化物和葡萄糖水平减低,差异有统计学意义(t=3.408~9.249,均P<0.011)。与真菌组、革兰阳性球菌组、革兰阴性杆菌组和对照组相比,革兰阳性杆菌组蛋白、腺苷脱氨酶(adenosine deaminase,ADA)和乳酸脱氢酶(lactic dehydrogenase,LDH)水平升高,差异有统计学意义(t=3.836~7.686,均P<0.037)。结论AIDS患者CNS感染和血流感染病原菌分布广泛,以真菌主。病原菌不同患者脑脊液相关检测指标不同,因此脑脊液生化指标可辅助诊断CNS感染。

Objective To analyze the distribution and drug sensitivity of pathogens and cerebrospinal fluid(CSF)related measurements in AIDS patients with central nervous system(CNS)infections in Chongqing,so as to provide guidance for etiological diagnosis and rational use of antibiotics in AIDS patients with CNS infections.Methods A total of 173 AIDS patients with CNS infections were divided into fungal group,Gram-positive bacilli group,Gram-positive cocci group and Gram-negative bacilli group.During the same period,198 AIDS patients with non-CNS infection visited this hospital were enrolled into the control group.CSF and blood were collected for bacterial culture.The composition and drug resistance of pathogens were analyzed.The levels of CSF related measurements were determined and compared.Results A total of 173 strains of pathogens were isolated from the CSF of the AIDS patients with CNS infections.The 173 strains included 101(58.38%)fungi,39(22.54%)Gram-positive bacilli,24(13.87%)Gram positive cocci and 9(5.20%)Gram-negative bacilli;230 strains of pathogens were isolated from the blood of the AIDS patients with non CNS infections.The 198 strains were composed of 107(54.04%)fungi,65(32.83%)Gram positive cocci and 26(13.13%)Gram-negative bacilli.Antifungal sensitivity testing result of Cryptococcus neoformans showed that MIC of amphotericin B,fluorocytosine,fluconazole,voriconazole and itraconazole were≤4,≤32,≤8,≤1 and≤1μg/ml.The resistance rate of Mycobacterium tuberculosis to rifampicin was 7.69%.The result of drug sensitivity of coagulase negative staphylococci isolated from patients with CNS infections and non-CNS infections were consistent.There were significant differences among Staphylococcus aureus,Enterobacteriaceae and Acinetobacter.Compared with the control group,the levels of protein were higher and the levels of chloride and glucose were lower in fungal group,Gram-positive bacteria group,Gram-positive coccus group and Gram-negative bacteria group(t=3.408-9.249,all P<0.011).The levels of protein,adenosine deaminase(ADA)and lactic dehydrogenase(LDH)in Gram-positive bacilli group were significantly higher than those in fungal group,Gram-positive coccus group,Gram-negative bacteria group and control group(t=3.836-7.686,all P<0.037).Conclusions The pathogens causing CNS and blood infections in AIDS patients were widely distributed,mainly dominated by fungus.The CSF related measurements varied with different pathogens,so as to assist in the etiological diagnosis of CNS infections.