艾滋病合并新型隐球菌脑膜炎16例临床分析

目的通过分析艾滋病合并新型隐球菌脑膜炎患者的临床特点,提高对该病的认识,为临床诊断和治疗提供参考。方法收集2009年3月～2012年3月住院治疗的16例艾滋病合并新型隐球菌脑膜炎患者临床资料,并进行回顾性分析。结果 16例艾滋病合并新型隐球菌脑膜炎患者,均有明显的免疫缺陷,CD4＋T淋巴细胞平均值为0.033×109/L。所有患者均有明显的中枢感染症状及体征,尤其颅内高压症状突出。脑脊液中均查见新型隐球菌,而脑脊液炎性反应相对较轻。多数患者合并有其他一种或多种机会性感染,主要有细菌性肺炎,霉菌性口腔炎、败血症（其中1例为新型隐球菌性败血症）。抗真菌治疗有效,但病死率仍高。结论艾滋病合并新型隐球菌脑膜炎患者病情复杂且较危重,病死率高。早期诊断,及时抗真菌治疗,以及适时开展抗反转录病毒治疗可以改善艾滋病合并新型隐球菌脑膜炎患者的预后。

The clinical characteristics of 16 cases of AIDS complicated with cryptococcal meningtis

Objective To investigate the clinical features of AIDS complicated with cryptococcal meningtis,to enhance the awareness of the disease and to reference the clinical diagnosis and treatment.Methods We retrospectively analyzed the clinical data of 16 AIDS cases complicated with cryptococcal meningtis.Results 16 cases of AIDS complicated with cryptococcal meningtis existed severally immunodeficiency and their average value of CD4 T lymphocyte was 0.033×109/L.All cases had obvious infection symptoms of central nervous system,especially more serious in acute intracranial hypertension.These patients were detected out cryptocococcus neoformans in the cerebrospinal fluid,in which inflammatory reaction was not conspicuous.Most of patients were complicated with one or more kind of opportunistic infection,such as bacterial pneumonia,fungus infection and septicemia.Anti-fungus treat was efficacious in these patients,but case fatality rate was still high.Conclusion The pathogenetic condition of patients suffered from AIDS complicated with cryptococcal meningtis was very complicated and very serious,and the case fatality rate was extremely high.Early diagnosis and therapy in time including anti-fungus and antiretrovirus may improve prognosis of the patients.