153例获得性免疫缺陷综合征患者并发中枢神经系统机会性感染的临床特征和预后影响因素

目的分析获得性免疫缺陷综合征（AIDS）患者并发中枢神经系统（CNS）机会性感染（OIs）的临床特点和预后影响因素。 方法收集2012年1月至2018年3月于武汉大学中南医院住院的153例临床诊断为AIDS并发CNS OIs患者的一般情况、临床表现、辅助检查、诊断、治疗以及预后等。随访半年，根据半年内患者是否死亡分为死亡组和生存组，采用多因素Logistic回归分析AIDS并发CNS OIs患者预后影响因素。 结果153例AIDS并发CNS OIs患者疾病诊断依次为新型隐球菌脑膜（脑）炎73例（47.7%），不明原因CNS感染27例（17.6%），混合感染性CNS疾病14例（9.2%），CMV性神经系统疾病12例（7.8%），弓形虫脑病12例（7.8%），结核性脑膜（脑）炎9例（5.9%），神经梅毒5例（3.3%），单纯疱疹病毒性脑膜脑炎1例（0.7%）。经对因和（或）对症治疗后，102例（66.7%）患者病情稳定，51例（33.3%）患者死亡。多因素Logistic回归分析显示意识障碍、肌力下降、外周血CD4⁺ T淋巴细胞计数< 25个/μl、并发EB病毒（EBV）血症均为AIDS并发CNS OIs患者死亡的独立危险因素（P = 0.000、0.014、0.012、0.005）。 结论AIDS并发CNS OIs的疾病诊断种类较多、诊疗难度大，且病死率高。CNS功能严重受损、免疫功能严重缺陷、并发EBV血症是AIDS并发CNS OIs患者死亡的主要危险因素。临床上需对上述高危患者进行早期筛查，早期发现CNS OIs并及时针对治疗可降低其发病率和病死率。

Clinical characteristics and prognostic factors of opportunistic infections of central nervous system in 153 patients with acquired immunodeficiency syndrome

ObjectiveTo analyze the clinical characteristics and prognostic factors of opportunistic infection (OIs) of central nervous system (CNS) in patients with acquired immunodeficiency syndrome (AIDS). MethodsThe clinical data of 153 patients with AIDS complicated with CNS OIs were collected from January 2012 to March 2018, the general conditions, clinical manifestations, auxiliary examinations, diagnosis, treatment and prognosis were analyzed, respectively. The patients with AIDS complicated with CNS OIs were divided into death group and survival group according to whether died within half a year. The prognostic factors of these patients were analyzed by multiple factors Logistic regression. ResultsAmong the 153 patients with AIDS complicated with CNS OIs, 73 (47.7%) cases were with Cryptococcus neoformans meningeal, 27 (17.6%) cases with unexplained CNS infection, 14 (9.2%) cases with mixed infectious CNS diseases, 12 (7.8%) cases with CMV neurological diseases, 12 (7.8%) cases with Toxoplasma gondii encephalopathy, 9 (5.9%) cases with tuberculous meningeal (brain) inflammation, 5 (3.3%) cases with neurosyphilis, 1 (0.7%) case with herpes simplex virus encephalitis. After treatment for causes and (or) symptoms, 102 (66.7%) patients were with stable condition and 51 patients died. Multivariate Logistic regression analysis showed disturbance of consciousness, decreased muscle strength, peripheral blood CD4⁺ T lymphocyte count < 25 cells/μl, Epstein-Barr virus (EBV) viremia were all independent risk factors associated with mortality of AIDS patients complicated with CNS OIs (P = 0.000, 0.014, 0.012, 0.005). ConclusionsAIDS complicated with CNS OIs had many diagnostic types, great difficulty in diagnosis and treatment, and high mortality. Severe impairment of CNS function, serious immunodeficiency and EBV viremia were independent risk factors associated with mortality. Early screening to identify the above mentioned high-risk patients were needed. Early detection of CNS OIs and timely targeted treatment could reduce the morbidity and mortality of these patients.