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目的总结艾滋病(AIDS)合并新型隐球菌性脑膜炎(CM)的临床、实验室检查特点与治疗转归。方法回顾性分析76例AIDS合并CM患者的临床资料。结果本组76例,男51例(67.1%),女25例(32.9%);中位病程30 d;头痛(97.4%)、发热(84.2%)、恶心呕吐(76.3%)是3大最常见的症状。局灶性神经功能缺损(38.2%)、精神异常(27.6%)及颈项强直(17.1%)相对少见,但出现这3种体征的患者的病死率显著高于阴性症状者(P<0.05)。49例(64.5%)患者颅内压升高,其中26例(34.2%)颅内压>330 mm H2O,其病死率高于颅内压<330 mm H2O者(P<0.05)。实验室检查CD4+T细胞计数的平均值为(55±49)个/μl。脑脊液中葡萄糖轻微降低[(2.0±1.1)mmol/L],蛋白轻微升高[(65±40)mg/dl]。脑脊液隐球菌培养阳性率为96.1%,印度墨汁染色阳性率为86.8%。头颅CT扫描异常者占34.2%,其中表现为局灶性低密度影10例,脑膜斑片强化7例,脑实质低密度影伴边缘强化2例,脑积水伴脑室扩大2例为相对典型影像学改变。本组CM的病死率为21.1%,复发率为28.9%。结论 CM是AIDS严重并发症,应早期诊断、早期治疗,以改善患者预后。
Objective To summarize the clinical and laboratory features and treatment outcome of AIDS complicated with cryptococcal meningitis (CM). Methods The clinical data of 76 AIDS patients with CM were retrospectively analyzed. Results The group of 76 patients, male 51 (67.1%), female 25 (32.9%); median duration of 30 d; headache (97.4%), fever (84.2%), nausea and vomiting (76.3% Common symptoms. Focal neurological deficit (38.2%), mental abnormality (27.6%) and neck stiffness (17.1%) were relatively rare, but those with these three signs were significantly more likely to die than those with negative symptoms (P <0.05). Intracranial pressure was higher in 49 patients (64.5%). Among them, 26 patients (34.2%) had intracranial pressure> 330 mm H 2 O and their mortality was higher than those with intracranial pressure <330 mm H 2 O (P <0.05). The average of laboratory test CD4 + T cell count was (55 ± 49) pieces / μl. There was a slight decrease in glucose in cerebrospinal fluid [(2.0 ± 1.1) mmol / L] and a slight increase in protein [(65 ± 40) mg / dl]. Cerebrospinal fluid Cryptococcus neoformans culture positive rate was 96.1%, Indian ink stain positive rate was 86.8%. Head CT scan abnormalities accounted for 34.2%, which showed 10 cases of focal low density, meningioma enhancement in 7 cases, low density of the brain with edge enhancement in 2 cases, hydrocephalus with ventricular enlargement in 2 cases are relatively typical Imaging changes. This group of CM mortality was 21.1%, the recurrence rate was 28.9%. Conclusion CM is a serious complication of AIDS and should be diagnosed early and treated early to improve prognosis.