艾滋病合并结核性脑膜炎32例临床分析

目的 探讨艾滋病合并结核性脑膜炎(TBM)的临床特征、诊断和治疗，提高艾滋病合并TBM的认识。 方法 回顾性总结1999年1月-2009年12月收治的32例艾滋病合并TBM的临床资料。 结果发热30例、头痛29例、意识障碍18例、抽搐12例，脑膜刺激征25例，咳嗽27例，咳痰25例。不同程度存在艾滋病相关表现。常合并肺结核（75%）及其他肺外结核（12.5%）。所有病例CD4＜200/mm³。脑脊液压力升高，白细胞升高，蛋白质升高，糖降低，氯化物降低,ADA 升高。结论 艾滋病合并TBM临床表现复杂，无特异性，病情重，致残率高，死亡率高。治疗上抗结核治疗+激素，适时联合HARRT治疗可降低病死率，提高生活质量，延长生命。

Clinical analysis on 32 AIDS cases coinfected with tuberculous meningitis

Objective To summary the clinical data from tuberculous meningitis（TBM） in patients coinfected with acquired immuno-deficiency syndrome（AIDS）. Methods We analyzed retrospectively 32 AIDS cases coinfected with tuberculous meningitis in our hospital from January 1999 to December 2009. Results There were 30 cases with fever,29 with headache,18 with disorder of consciousness,12 with spasm,25 with meningismus,27 with cough,and 25 with productive cough.All the patients had different degrees of AIDS-related presentation and were often coinfected with pulmonary tuberculosis（75%） and extra-pulmonary tuberculosis（12.5%）.CD4 count was less than 200/mm3 in all cases.All the patients presented with increased cerebrospinal fluid pressure,WBC,protein and ADA,and with decreased sugar and chloride in the cerebrospinal fluid. Conclusions The AIDS patients coinfected with tuberculous meningitis have complex,severe and nonspecified clinical manifestation with high mortality and high disable rates.Antituberculosis plus corticoid and combination treatment with HARRT can decrease mortality,improve life quality and extend life-span.