血浆(1-3)-β-D葡聚糖对AIDS合并CM预后评估价值研究

Study on the Prognostic Value of Plasma(1-3)-β-D Glucan in AIDS Complicated with Cryptococcal Meningitis

目的:探讨血浆(1-3)-β-D葡聚糖对获得性免疫缺陷综合症(Acquired Immune Deficiency Syndrome,AIDS)合并隐球菌性脑膜炎(Cryptococcal meningitis,CM)患者预后评估的价值。方法:回顾性分析2015年1月1日至2020年12月31日贵阳市公共卫生救治中心收治的66例AIDS合并CM患者的临床病例资料,按照1年内生存状况分为生存组(56例)和死亡组(10例),收集两组患者性别、年龄、传播途径、临床症状(头痛、发热、呕吐及意识障碍),头颅影像学检查、入院时实验室检查(CD4^(+)T淋巴细胞计数、血浆HIV-RNA病毒载量、外周血血红蛋白、外周白细胞计数、外周血中性粒细胞计数、C反应蛋白、血沉、PCT、脑脊液葡萄糖、脑脊液氯化物及脑脊液蛋白、脑脊液培养、脑脊液涂片、血液隐球菌培养、血浆(1-3)-β-D葡聚糖浓度)及抗真菌治疗后第一次血浆(1-3)-β-D葡聚糖浓度。多因素Logistic回归分析AIDS合并CM患者死亡危险因素。受试者工作特征曲线ROC分析血浆(1-3)-β-D葡聚糖浓度预测AIDS合并CM患者死亡的价值。结果:单因素分析显示PCT、CD4+T淋巴细胞、血浆(1-3)-β-D葡聚糖浓度是AIDS合并CM患者死亡危险因素(P均<0.05)。多因素Logistic回归分析显示高浓度血浆(1-3)-β-D葡聚糖是AIDS合并CM患者独立死亡危险影响因素(P<0.05)。ROC曲线分析显示,抗真菌治疗前血浆(1-3)-β-D葡聚糖为65.63pg/mL时患者死亡的曲线下面积最大(0.787,95%CI 0.665~0.910),其敏感度和特异度较高(分别为90.0%和62.5%,P<0.05)。结论:血浆(1-3)-β-D葡聚糖对AIDS合并CM患者预后具有较高的评估价值,当血浆(1-3)-β-D葡聚糖>65.63pg/mL提示患者死亡风险高。

Objective:To study the value of plasma(1-3)-β-D glucan in evaluating the prognosis of acquired immune deficiency syndrome(AIDS)complicated with Cryptococcal meningitis(CM).Methods:The clinical data of 66 AIDS patients complicated with CM from January 1,2015 to December 31,2020 were analyzed retrospectively,and they were divided into survival group(56 cases)and death group(10 cases)according to their living conditions within one year.We collected the gender,age,route of transmission,clinical symptoms(headache,fever,vomiting and disturbance of consciousness),head imaging examination,laboratory examination at admission(CD4^(+)T lymphocyte count,plasma HIV-RNA viral load,peripheral blood hemoglobin,peripheral white blood cell count,peripheral blood neutrophil count,C-reactive protein,ESR,procalcitonin,cerebrospinal fluid glucose,cerebrospinal fluid chloride and cerebrospinal fluid protein,cerebrospinal fluid culture,cerebrospinal fluid smear,culture of Cryptococcus in blood,plasma(1-3)-β-D glucan concentration)and the first plasma(1-3)-βafter antifungal treatment.Multivariate Logistic regression analysis of death risk factors in AIDS patients complicated with CM.The value of receiver operating characteristic curve ROC in predicting the death of AIDS patients complicated with CM by analyzing plasma(1-3)-β-D glucan.Results:Univariate analysis showed that PCT,CD4+lymphocyte and plasma(1-3)-β-D glucan concentration were the risk factors for death of AIDS patients with CM(P<0.05).Multivariate Logistic regression analysis showed that high concentration of plasma(1-3)-β-D glucan is an independent risk factor for death in patients with AIDS complicated with CM(P<0.05).ROC curve analysis showed that the area under the curve was the largest(0.787,95%CI 0.665~0.910).when plasma(1-3)-β-d glucan was 65.63pg/ml before antifungal treatment,and its sensitivity and specificity were higher(90.0%and 76.8%,respectively)(P<0.05).Conclusion:Plasma(1-3)-β-D-glucan has a high value in evaluating the prognosis of patients with AIDS complicated with CM,and plasma(1-3)-β-D-glucan>65.63pg/ml indicates a high risk of death.