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目的探讨艾滋病合并隐球菌病的临床特点及影响预后的相关因素。方法采集艾滋病合并隐球菌病住院患者43例的流行病学资料、临床表现、影像学检查、实验室检查、体格检查及疾病转归情况,统计分析影响预后的相关因素。结果 88.37%患者出现中枢神经系统感染,65.12%患者出现中枢神经系统合并肺部感染。经系统抗真菌治疗后总病死率为27.91%。出现昏迷患者病死率为71.43%,死亡病例平均脑脊液压力为297.8mm H2O,中枢神经系统合并肺部感染患者病死率为42.86%。死亡病例CD4+T细胞计数为(37.2±27.1)cells/μL,显著低于存活病例CD4+T细胞计数(74.0±59.4)cells/μL。未接受HAART治疗患者病死率为37.50%,死亡病例平均年龄显著高于存活病例。结论艾滋病合并隐球菌病患者易累及中枢神经系统和肺部,脑脊液压力高、昏迷、多器官受累、低CD4+T细胞计数、未接受HAART治疗、老年患者是艾滋病合并隐球菌病患者死亡的高危因素。
Objective To investigate the clinical characteristics of AIDS complicated with cryptococcosis and related factors that affect the prognosis. Methods Epidemiological data, clinical manifestations, imaging examination, laboratory examination, physical examination and disease outcome were collected from 43 inpatients with AIDS-associated cryptococcosis. Statistic analysis was made on the factors influencing prognosis. Results The central nervous system infection occurred in 88.37% of patients and the central nervous system complicated pulmonary infection in 65.12% of patients. The total case fatality rate after systemic antifungal treatment was 27.91%. The mortality of comatose patients was 71.43%, mean CSF CSF pressure was 297.8mmH2O, and death rate was 42.86% in central nervous system patients with pulmonary infection. The CD4 + T cell count of deaths was (37.2 ± 27.1) cells / μL, which was significantly lower than that of surviving CD4 + T cells (74.0 ± 59.4) cells / μL. The mortality of patients without HAART was 37.50%, the average age of death cases was significantly higher than the survival cases. Conclusions Patients with AIDS complicated with cryptococcosis are likely to be involved in the central nervous system and lungs, with high cerebrospinal fluid pressure, coma, multiple organ involvement, low CD4 + T cell count, and no HAART treatment. Elderly patients are at high risk of death from AIDS with cryptococcosis factor.