348例HIV/AIDS病人血清隐球菌抗原筛查的结果分析

目的分析在艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)中,应用血清隐球菌抗原筛查隐球菌感染的结果,为开展相关研究提供依据。方法对2012年10月至2013年7月,在贵阳市第五人民医院住院的348例HIV/AIDS病人进行血清隐球菌抗原检查,同时检查病人的CD+4T淋巴细胞(简称CD4细胞)计数;对血清隐球菌抗原阳性病人进行血培养、脑脊液(CSF)隐球菌抗原检查、墨汁染色及培养。结果 348例病人中,男256例,女92例,年龄19~77岁,平均(40.50±13.05)岁。血清隐球菌抗原阳性34例,阳性率9.77%(34/348),CD4细胞计数为0~1097个/mm3,中位数56个/mm3。CD4细胞计数≤50个/mm3组146例,50个/mm3组202例。CD4细胞计数≤50个/mm3和50个/mm3组病人阳性例数分别为24例和10例,阳性率为16.44%(24/146)和4.95%(10/202),两组间差异有统计学意义(u=3.56,P0.01)。血清隐球菌抗原阳性病人血培养阳性3例,CSF隐球菌抗原阳性27例,墨汁染色阳性22例,CSF培养阳性15例;34例病人中最后确认隐球菌感染33例。所有诊断隐球菌感染的病人血清隐球菌抗原均为阳性。结论 HIV/AIDS病人血清隐球菌抗原阳性率高,血清隐球菌抗原筛查有助于及时诊断隐球菌病,特别是CD4细胞计数≤50个/mm3的病人,推荐普遍检查。

Result analysis of serum cryptococcal antigen screening among 348 HIV/AIDS patients

Objective To study the utility of serum cryptococcal antigen （CrAg） screening among 348 HIV/ AIDS patients and provide the basis for further research. Methods Serum CrAg and CD4＋ T lymphocytes were detected in 348 HIV/AIDS patients hospitalized in our hospital from Oct. 2012 to Jul. 2013. Serum CrAg positive patients were tested for blood culture, cerebrospinal fluid （CSF） CrAg, CSF culture and CSF india ink stain. Results Of the 348 patients enrolled, 9.77%（34/348） was serum CrAg positive. CD4 cell counts ranged from 0 to 1,097 cells/mm3 , with the median of 56 cells/mm3. There were 256 males and 92 females, with the age ranged from 19 to 77 years old and the mean of 40.50±13.05 years old. There were 146 cases in group of CD4 cell counts ≤ 50 cells/ mm3 , 202 cases in group of CD4 cell cousnts ≤ 50 cells/mm3. In the group of CD4 cell counts ≤50 cells/mma and that 〉 50 cells/mm3 , 24 and 10 were positive, with the positive rate of 16.44% （24/146） and 4.95% （10/202）, respectively. The differences between the two groups were statistically significant （u = 3.56, P ~0.01）. Three patients were blood culture positive, 27 were CSF CrAg positive, 22 were CSF india ink strain positive and 15 were CSF culture positive. Among the 34 serum CrAg positive patients, 33 were confirmly diagnosed as cryptococcosis. All patients diagnosed as cryptococcosis were serum CrAg positive. Conclusions Serum CrAg prevalence was higher among HIV/AIDS patients. Serum CrAg screening would be useful in diagnosing cryptococcosis in time among HIV/AIDS patients. Serum CrAg screening were strongly recommended in HIV/AIDS adults, especially those with CD＋ T lymphocyte counts 〈50cells/mm3.