艾滋病并发隐球菌脑膜炎14例临床分析

目的分析艾滋病(AIDS)并发隐球菌脑膜炎临床特点,为临床诊治提供信息。方法对近3年北京佑安医院收治的14例AIDS并发隐球菌脑膜炎患者的临床资料进行回顾性分析。结果 14例患者均以头痛为主诉入院,10例(71.4%)有发热、呕吐等主要伴随症状,脑膜刺激征及视神经乳头水肿的发生率也较高,分别为7例(50.0%)和8例(57.1%),抽搐及意识障碍等脑实质受损的表现发生率较低,分别为3例和2例。85.7%(12/14)的患者CD4+T淋巴细胞<100/μL。85.7%(12/14)的患者颅内压增高,其中一半患者脑脊液压力大于35 cmH2O,13例(92.9%)患者的脑脊液细胞数和9例患者(64.3%)的脑脊液蛋白水平轻度增高,6例(42.9%)脑脊液葡萄糖水平减低,8例(57.1%)氯化物水平减低。11例(78.6%)脑脊液隐球菌涂片阳性,6例(42.9%)脑脊液隐球菌培养阳性,12例(85.7%)脑脊液隐球菌荚膜多糖抗原检测阳性。4例(28.6%)头颅CT或核磁共振检查表现异常,包括脑实质损伤2例,脑积水1例及占位性病变1例。经治疗2例(14.3%)死亡,1例自动出院,11例病情好转出院,平均住院天数为60 d。结论 AIDS并发隐球菌脑膜炎的患者多以头痛为主诉,伴发热及颅内压增高等表现多见,而脑实质损伤的表现较少。患者的CD4+细胞数多低于100/μL,脑脊液压力大多明显增高,隐球菌抗原检测灵敏度较高,而影像学检查很少有特异性发现。该病目前的诊断及治疗仍相对困难,临床医师应当予以更多的重视。

AIDS complicated with cryptococcal meningitis:report of 14 cases

Objective To analyze the clinical characteristics of AIDS patients complicated with cryptococcal meningitis,and provide information for clinical management.Methods Fourteen AIDS cases complicated with cryptococcal meningitis admitted to Beijing You’an Hospital in the past 2 years were analyzed retrospectively.Results The chief complaint was headache in all the 14 patients of this analysis.Fever and vomiting were the accompanying symptoms in 10(71.4%) patients.Meningeal irritation signs and papilledema were observed in 7(50.0%) and 8(57.1%) patients,respectively.Convulsion and disturbance of consciousness were observed in 3 and 2 cases respectively.Elevated intracranial pressure was seen in 12(85.7%) cases.CSF pressure was over 35 cmH2O in 6 of these cases.The elevated CSF cell counts were seen in 13 cases(92.9%),elevated protein levels in 9(64.3%) patients,increased glucose in 6(42.9%),and decreased chloride in 8(57.1%) cases.Cryptococcus was found in 78.6%(11/14) CSF smears.Culture was positive in 42.9%(6/14) patients.The cryptococcal capsular polysaccharides antigen in CSF was positive in 12(85.7%) of the 14 patients.Four patients had abnormal brain CT or MRI finding,including brain parenchymal damages in 2 cases,brain hydrocephalus and space-occupying lesion in one patient each.Of the 14 patients,2(14.3%) died,1(7.1%) left the hospital voluntarily,and 11(78.6%) were cured.The mean hospital stay was 60 days.Conclusions In the AIDS patients complicated with cryptococcal meningitis,the most common chief complaint is headache.The patients usually have fever and elevated intracranial pressure.Brain parenchymal damage is rarely seen.CD4+ count is usually lower than 100/μL.CSF pressure is elevated significantly.Cryptococcal antigen assay is a sensitive test.Imaging examination is less specific.The diagnosis of cryptococcal meningitis is still difficult,which requires the physicians to pay more attention.