168例艾滋病合并中枢神经系统机会性感染病例的临床分析

目的探讨艾滋病病人合并机会性中枢神经系统感染（CNS）的发病率、临床特点及与CD^＋_4T淋巴细胞（简称CD_4细胞）的关系。方法回顾分析马拉维2013年3月至2013年9月收治的艾滋病病人中,CNS感染的病例资料,数据录入Excel进行处理。结果 1023例艾滋病病人中,合并机会性CNS 168例,发病率16.42%（168/1023）。其中合并隐球菌脑膜（脑）炎占47.02%（79/168）,结核性脑膜（脑）炎占24.40%（41/168）,弓形虫脑炎占19.05%（32/168）,不明原因的CNS感染占7.74%（13/168）,巨细胞病毒（CMV）性脑炎占1.79%（3/168）。检测的136例病人CD4细胞计数为8～493/mm3,平均为98.56/mm3。其中CD4细胞〈50/mm3 22例,51～100/mm345例,101～200/mm3 44例,201～350/mm3 10例,〉350/mm3 15例。118例好转出院,死亡50例,死亡率29.76%（50/168）;以CD4细胞〈100/mm3最为常见。结论机会性CNS感染是艾滋病晚期常见的并发症,表现复杂多样,病情重,主要发生于CD4细胞〈200/mm3的病人,且病死率高。早诊断、及时治疗可以延长艾滋病病人的生命。

Clinical analysis of 168 AIDS patients with opportunistic infections of the central nervous system

Objective To investigate the incidence and clinical characteristics of opportunistic infections of the central nervous system（CNS）and their relationship with CD^＋_4T lymphocytes in AIDS patients.Methods Clinical data were retrospectively analyzed in AIDS patients with opportunistic infections of the CNS Malawi from March2013 to September 2013.the data was processed by Excel.Results There were 168 cases with opportunistic infections of the CNS among 1023 cases of AIDS,with the incidence of 16.42%,（168/1023）.Among which Cryptococcal meningitis（encephalitis）accounted for 47.02%（79/168）,tuberculosis meningitis（encephalitis）24.40%（41/168）,toxoplasmosis encephalitis 19.05%（32/168）,unknown infection of CNS 7.74%（13/168）and CMV encephalitis1.79%（3/168）.CD＋4T lymphocytes were detected in 136 cases.The range of CD4 cell count was 8～493/mm3,with the average of 98.56/mm3.There were 22 cases with CD4 cell count50/mm3,45 cases of 51-100/mm3,44 cases of 101-200/mm3,10 cases of 201-350/mm3 and 15cases350/mm3.Condition got better in 118 cases.There were 50 cases died,with the mortality of 29.76%（50/168）,most commonly in patients withCD4 cell counts100/mm3.Conclusion Opportunistic infections of the CNS are common complications of advanced AIDS,with diverse and complex manifestations,severe conditions,and mainly occurred in patients with CD4 cell counts200/mm3.The mortality rate is high.Early diagnosis and timely treatment can extend the life of AIDS patients.