艾滋病合并隐球菌脑膜炎临床特征及预后影响因素

Clinical characteristics of AIDS patients complicated with cryptococcal meningitis and influencing factors for prognosis

目的探讨艾滋病合并隐球菌脑膜炎临床特征及预后影响因素。方法回顾性分析2012年1月-2018年7月在武汉大学中南医院住院治疗的90例艾滋病合并隐球菌脑膜炎患者的临床数据,分析患者临床特征及影响预后的相关因素。结果艾滋病合并隐球菌脑膜炎患者最常见的临床表现是发热90.00%(81/90)、头晕头痛83.33%(75/90)和恶心呕吐58.89%(53/90);脑脊液中隐球菌抗原、墨汁染色及培养的阳性率分别为92.59%(50/54)、78.89%(71/90)和51.11%(46/90);经系统抗真菌治疗后总病死率为25.56%(23/90);影响艾滋病合并隐球菌脑膜炎患者12周预后单因素分析显示:病死组患者联合抗逆转录病毒治疗(cART)、意识障碍、痫性发作、颈项强直、低CD_(4)^(+)T细胞计数患者例数及全身播散性隐球菌感染发生率较生存组高,差异有统计学意义(P<0.05);多因素Logistic回归分析显示:意识障碍、颈项强直及痫性发作是影响患者12周预后的危险因素。结论艾滋病合并隐球菌脑膜炎患者常伴播散性感染,意识障碍、颈项强直及痫性发作是艾滋病合并隐球菌脑膜炎患者预后不良的危险因素,对CD4+T细胞计数<100个/μl的患者开始cART前应常规筛查隐球菌抗原,早诊断治疗,可能进一步降低病死率。

OBJECTIVE To explore the clinical characteristics of acquired immune deficiency syndrome(AIDS)patients complicated with cryptococcal meningitis and influencing factors for prognosis.METHODS The clinical data of 90 AIDS patients complicated with cryptococcal meningitis who were hospitalized in Zhongnan Hospital of Wuhan University from Jan 2012 to Jul 2018 were retrospectively analyzed,and the clinical characteristics and influencing factors for prognosis were observed.RESULTS Among the most common clinical manifestations of the AIDS patients complicated with cryptococcal meningitis,90.00%(81/90)had fever,83.33%(75/90)had dizziness or headache,and 58.89%(53/90)had nausea and vomiting.The positive rates of cryptococcus antigen,ink staining and culture of the cerebrospinal fluid were 92.59%(50/54),78.89%(71/90)and 51.11%(46/90),respectively.The total mortality rate was 25.56%(23/90)after antifungal treatment.Univariate analysis of the influencing factors for 12-week prognosis of the AIDS patients complicated with cryptococcal meningitis showed that the number of the patients with had antiretroviral therapy(cART),disturbance of consciousness,seizures,rigid neck and low CD4+T cell counts was significantly larger in the death group than in the survival group,the incidence rate of systemic disseminated cryptococcal infection of the death group was significantly higher than that of the survival group(P<0.05).Multivariate logistic regression analysis indicated that disturbance of consciousness,seizures and rigid neck were the risk factors for the 12-week prognosis of the patients.CONCLUSION The AIDS patients with cryptococcal meningitis are usually complicated with disseminated infection.The disturbance of consciousness,seizures and rigid neck are the risk factors for poor prognosis of the AIDS patients complicated with cryptococcal meningitis.It is necessary to carry out the routine cryptococcus antigen test for the patients with CD_(4)^(+)T cell counts less than 100/μl before cART so as to make a early diagnosis and treatment and further reduce the mortality rate.