艾滋病合并新型隐球菌脑膜炎不同治疗方案的疗效观察

目的观察不同治疗方案治疗艾滋病合并新型隐球茵脑膜炎（CM）的临床疗效。方法将艾滋病合并CM患者46例分为两组，观察组25例采用两性霉素B和氟康唑静脉滴注，同时辅以两性霉素B加地塞米松鞘内注药；对照组21例仅采用两性霉素B和氟康唑静脉滴注，观察两组患者的疗效。结果经过6周治疗，观察组中临床症状明显好转，复查脑脊液墨汁染色试验阴性17例（68．0％）；死亡4例，病死率16．0％；临床症状好转，但复查脑脊液墨汁染色试验仍阳性4例。对照组中临床症状明显好转，复查脑脊液墨汁染色试验阴性11例（52．4％）；死亡6例，病死率28．6％；临床症状好转，但复查脑脊液墨汁染色试验仍阳性4例。死亡病例CIM＋T细胞计数〈100个／μ1。两组病死率及治疗后脑脊液墨汁染色阴转率比较，差异均无统计学意义（P〉0．05）。结论CD4＋T细胞计数低下的艾滋病合并CM患者病死率高，全身应用抗真菌药物的同时辅以鞘内注药的疗效未见明显优势。

Observation on Curative Effect of Different Therapies for AIDS Patients with Novel Cryptococcal Meningitis

Objective To investigate the curative effects of different therapies for AIDS patients with novel cryptococcal meningitis（CM）. Methods Forty-six AIDS patients with CM were divided into two groups. The 25 patients in the observation group were given intravenous drip of amphotericin B and fluconazol as well as intrathecal injection of amphotericin B and dexamethasone. The 21 patients in the control group were given intravenous drip of amphotericin B and fluconazol. The effects of both groups were observed. Results After 6-week treatment, 17 （68.0%） patients of observation group were obviously better, whose results of cerebrospinal fluid India ink staining showed negative. Four patients of observation group were dead,and the mortality was 16.0%. Another 4 patients were better,but their results of cerebrospinal fluid India ink staining were positive. Eleven（52. 4% ） patients were obviously better in the control group,whose results of cerebrospinal fluid india ink staining showed negative.Six patients in the control group were dead,and the mortality was 28. 6%. Another 4 patients were better,but their results of cerebmspinal fluid India ink staining were still positive. The CD4＋T cell counting of all the death was 〈100/IA. No significant difference was found in the mortality and the negative conversation rate of cerebmspinal fluid Indiainkstaining after treatment between two groups （P 〉 0. 05）. Conclusion AIDS patients with CM with low CD4＋ T cell counting have a high mortality. The curative effects of antimycotic assisted by intrathecal injection for AIDS patients with CM aren＇t of obvious advantages.