32例AIDS伴发中枢神经系统感染病人临床分析

目的分析艾滋病(AIDS)住院病人中,中枢神经系统感染的发病率、疾病谱及临床特点。方法对2009-2011年,在北京佑安医院住院治疗的AIDS伴发中枢神经系统感染病人的临床资料进行回顾总结,对其临床表现、诊治、转归等进行分析。结果 502例AIDS住院病人中,伴发中枢神经系统感染者32例,发生率6.4%。主要症状包括头痛23例(71.9%)、发热23例(71.9%)、呕吐20例(62.5%)、脑膜刺激征12例(37.5%)、肢体活动障碍9例(28.1%)、意识障碍7例(21.9%)等。这些病人的CD4细胞中位数为31/mm3,其中,≤100/mm3者27例,占总数的84.4%。诊断包括:隐球菌脑膜脑炎13例(40.6%),弓形体脑病10例(31.3%),结核性脑膜炎5例(15.6%),真菌性脑炎3例(9.4%),巨细胞病毒(CMV)脑炎1例(3.1%)。最终,32例病人中有22例(68.8%)治愈出院,5例(15.6%)死亡,5例(15.6%)未愈出院。结论 AIDS病人中枢神经系统感染以发热、头痛、呕吐、脑膜刺激征阳性等症状体征比较多见,主要发生于CD4细胞较低的病人,且病死率高,在临床中应引起重视。

Clinical analysis of 32 AIDS cases complicated with central nervous system infections

Objective To investigate the incidence,disease spectrum and clinical characteristics of neurological infections among hospitalized AIDS patients.Methods Clinical presentation,diagnosis,management and prognosis of AIDS inpatients complicated with neurological infections in Beijing You’an Hospital from 2009 to 2011 were analyzed retrospectively.Results Neurological infections were observed in 32(6.4%) out of 502 AIDS inpatients,their main symptoms included headache in 23 cases(71.9%),fever in 23 cases(71.9%),vomiting in 20 cases(62.5%),positive meningeal irritation signs in 12 cases(37.5%),movement disorder of limbs in 9 cases(28.1%),and disturbance of consciousness in 7 cases(21.9%).The median CD4 cell counts in them were 31/ mm3,and 84.4% of them were ≤100/ mm3.Final diagnoses were: cryptococcal meningitis in 13 cases(40.6%),cerebral toxoplasmosis in 10 cases(31.3%),tuberculosis meningitis in 5 cases(15.6%),fungal infection in 3 cases(9.4%),and CMV encephalitis in 1 cases(3.1%).A total of 22 cases(68.8%) were cured or relieved when they discharged,and 5 cases(15.6%) had no remission and 5 cases(15.6%) died.Conclusions It is common to see neurological infections among HIV/AIDS inpatients,especially among those whose CD4 cell counts were below 100/ mm3,and those with headache,fever,vomiting and other symptoms should undergo timely examinations,such as cerebrospinal fluid examination and or head CT or MRI.