艾滋病合并新型隐球菌性脑膜炎100例临床分析

目的 分析艾滋病合并新型隐球菌性脑膜炎的临床特点、治疗及转归,提高对隐球菌性脑膜炎的认识.方法 回顾性总结2008年1月至2012年12月在广州医科大学附属广州市第八人民医院住院治疗的艾滋病合并隐球菌性脑膜炎的临床表现、实验室检查、治疗及转归.结果 100例确诊患者中,男75例,女25例,平均年龄（39.5±10.3）岁,Charlson合并症指数为（6.1±0.7）,所有患者均未接受高效抗逆转录病毒治疗（HAART）.发热和头痛是最常见的临床症状.CD4细胞计数1～ 139/μl（中位数8.5）.98例患者入院初次脑脊液压力升高,平均为（21.2±12.4）mmHg.脑脊液白细胞中位计数2（1 ～ 110）× 10^6/L,中位蛋白质定量为0.41 g/L（0.11 ～1.43 g/L）,葡萄糖含量中位数为0.42 g/L（0.05～ 0.69g/L）.88例患者脑脊液墨汁染色找到隐球菌,81例患者脑脊液培养阳性,88例患者脑脊液隐球菌抗原阳性,99例患者血清隐球菌抗原阳性.中位疗程23天,各治疗组间临床转归差异无统计学意义（Х^2=4.387,P=0.821）.结论 艾滋病并发新型隐球菌性脑膜炎是艾滋病常见机会性感染,临床表现及实验室检查缺乏特异性,减少病死率的关键在于早期诊断,早期合理地使用抗真菌药物.

Clinical analysis on 100 cases of AIDS combined with cryptococcal meningitis

Objective To analyze the clinical features and prognosis of cryptococcal meningitis in patients with AIDS,and to improve the understanding of cryptococcal meningitis.Methods We retrospectively analyzed the clinical data of cryptococcal meningitis in patients with AIDS from January 2008 to December 2012 in Guangzhou 8th People＇s Hospital.The data of clinical manifestation,laboratory examination,treatment and prognosis were collected.Results Among all 100 cases diagnosed as AIDS associated with cryptococcal meningitis,75 cases were male and 25 cases were female,mean age was （39.5 ± 10.3） years old.Charlson comorbidity index was （6.1 ± 0.7）.All patients were not receiving HAART.Fever and headache were the most common clinical symptoms.CD4 cell count was 1～ 139/μ l （median 8.5）.98 patients had increased open pressure mean （21.2 ± 12.4） mmHg].Median CSF WBC count was 2 （1-110） × 10^6/L,the median protein quantification was 0.41 g/L （0.11-1.43 g/L）,median glucose 0.42 g/L （0.05-0.69 g/L）.88 patients had positive India ink smear,81 patients were cerebrospinal fluid culture positive,88 cases had positive CSF cryptococcal antigen and 99 patients were serum cryptococcal antigen positive.The median duration was 23 days.There were no significant difference of clinical outcomes among different treatment groups （Х^2=4.387,P=0.821）.Conclusion Cryptococcal meningitis is the common opportunistic infection in patients with AIDS.The clinical manifestations and laboratory tests lack specificity.The key to reducing mortality is early diagnosis and rational use of antifungal agents.