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目的探讨AIDS合并新型隐球菌性脑膜脑炎患者的临床特征及转归。方法回顾性分析2011-2013年北京佑安医院住院的42例AIDS合并隐球菌性脑膜脑炎患者的临床表现、实验室检查、治疗转归及相关影响因素。结果头痛(39例,92.9%)及发热(24例,57.1%)是最常见的首发症状,颈项强直及意识障碍也较为常见(各18例,42.9%)。CD4+T淋巴细胞计数中位数为18(4~419)个/mm3。脑脊液压力≥200 mm H2O 39例(92.9%)。脑脊液蛋白定量0.4(0.1~13.7)g/L,13例(31.0%)患者的脑脊液蛋白>2 g/L;糖为3.0(0.1~4.7)mmo L/L;氯化物为117.0(102.3~125.1)mmo L/L;细胞数为12(0~56)×106/L,单核细胞占68.7(0.0~100.0)%。总病死率为23.8%。颈项强直、意识障碍、病理征阳性、较低的基线CD4+T淋巴细胞及尚未启动抗病毒治疗与较差的预后(死亡)显著相关(P<0.01)。59.5%的患者应用两性霉素B及氟康唑联合抗真菌治疗,有效率为76.0%,与两性霉素B联合5-氟胞嘧啶的疗效相当(P>0.05)。结论对疑似AIDS合并新型隐球菌性脑膜脑炎的病例应及时行脑脊液检测及病原学检查以明确诊断,降低隐球菌病病死率的关键是早期诊断和治疗。
Objective To investigate the clinical features and prognosis of AIDS complicated with neoformans meningoencephalitis. Methods The clinical manifestations, laboratory tests, treatment outcome and related factors of 42 AIDS-refractory meningococcal meningoencephalitis patients hospitalized in Beijing You’an Hospital from 2011 to 2013 were retrospectively analyzed. Results Headache (39 cases, 92.9%) and fever (24 cases, 57.1%) were the most common initial symptoms. Neck stiffness and disturbance of consciousness were also common (18 cases, 42.9%). The median CD4 + T lymphocyte count was 18 (4 to 419) / mm3. Cerebrospinal fluid pressure was ≥200 mm H 2 O 39 cases (92.9%). Cerebrospinal fluid protein was 0.4 (0.1 to 13.7) g / L in 13 patients (31.0%), and cerebrospinal fluid protein was> 2 g / L in patients with 3.0 to 0.1 mmole / L glucose and 117.0 (102.3 to 125.1 ) mmo L / L; the number of cells was 12 (0 ~ 56) × 106 / L, mononuclear cells accounted for 68.7 (0.0 ~ 100.0)%. The total case fatality rate was 23.8%. Neck stiffness, disturbance of consciousness, positive pathology, low baseline CD4 + T lymphocytes, and antiviral therapy were not significantly associated with poor prognosis (death) (P <0.01). 59.5% of the patients with amphotericin B and fluconazole combined antifungal therapy, the effective rate was 76.0%, and amphotericin B combined 5-fluorocytosine efficacy (P> 0.05). Conclusions The diagnosis of cryptococcal neoplasia with suspected AIDS complicated with meningococcal meningoencephalitis should promptly detect cerebrospinal fluid (CSF) and pathogenic examination to confirm the diagnosis. The key to reduce the mortality of cryptococcosis is early diagnosis and treatment.