艾滋病合并播散性隐球菌病116例临床特征及预后分析

Analysis on Clinical Characteristics and Prognosis of 116 Cases of AIDS Complicated with Disseminated Cryptococcosis

目的:分析艾滋病合并播散性隐球菌病的临床特征及预后。方法:回顾性收集2009年7月-2018年8月云南省传染病医院诊断为AIDS合并播散性隐球菌病116例患者的临床资料。对116例艾滋病合并播散性隐球菌病患者的流行病学、临床表现、实验室检查、治疗及预后等进行统计分析。结果:临床表现以头痛、发热、体重下降、脑膜刺激征阳性、恶心、呕吐、乏力纳差、咳嗽咳痰为主;80.1%的患者CD4^(+)T淋巴细胞计数小于100 cells/μl;血液和脑脊液同时检出隐球菌占62.1%;抗真菌治疗以两性霉素B联合氟康唑为主(占58.6%);经以抗真菌等治疗后死亡率为19.0%;死亡组CD4^(+)T淋巴细胞计数低于存活组,差异有统计学意义(P<0.05);死亡组平均脑脊液压力、脑脊液蛋白、脑脊液白细胞均高于存活组,差异均有统计学意义(P<0.05);两组意识障碍、抽搐、语言障碍、巴宾斯基征阳性、大小便失禁、脑膜刺激征阳性、HAART治疗情况比较,差异均有统计学意义(P<0.05)。结论:艾滋病合并播散性隐球菌病临床表现多样,好发于CD4^(+)T淋巴细胞计数低的人群,容易出现血流感染和中枢神经系统侵犯,即使经过抗真菌治疗仍有较高的死亡风险,尤其是CD4^(+)T淋巴细胞计数低下和未行HAART的患者,应积极筛查和治疗播散性隐球菌病。

Objective:To analyze the clinical characteristics and prognosis of AIDS complicated with disseminated cryptococcosis.Method:The clinical data of 116 patients with AIDS and disseminated cryptococcosis diagnosed in Yunnan Infectious Disease Hospital from July 2009 to August 2018 were retrospectively collected.The epidemiology,clinical manifestation,laboratory examination,treatment and prognosis of 116 patients with AIDS complicated with disseminated cryptococcosis were statistically analysed.Result:The main clinical manifestations were headache,fever,weight loss,positive meningeal irritation,nausea,vomiting,anorexia,cough and expectoration;80.1%of patients had CD4^(+)T lymphocyte count less than 100 cells/μl;cryptococcus in blood and cerebrospinal fluid accounted for 62.1%;Amphotericin B combined with Fluconazole was the main antifungal therapy(58.6%);the mortality was 19.0%after antifungal treatment.The CD4^(+)T lymphocyte count in the death group was lower than that in the survival group,the difference was statistically significant(P<0.05);the mean cerebrospinal fluid pressure,cerebrospinal fluid protein and cerebrospinal fluid leukocytes in the death group were higher than those in the survival group,the differences were statistically significant(P<0.05);there were significant differences in consciousness disorder,convulsion,language disorder,positive Babinsky sign,incontinence,positive meningeal stimulation sign and HAART treatment between two groups(P<0.05).Conclusion:The clinical manifestations of AIDS complicated with disseminated cryptococcosis are diverse,it usually occurs in people with low CD4^(+)T lymphocyte count,and is prone to blood flow infection and central nervous system invasion.Even after antifungal treatment,there is still a high risk of death,especially in patients with low CD4^(+)T lymphocyte count and without HAART,disseminated cryptococcosis should be actively screened and treated.