HIV-1阳性弓形虫脑病患者临床特征  

Clinical characteristics of HIV-1 positive toxoplasmic encephalopathy patients

作　　者：刘波[1] 李雯 赵涵[1] 冯理智 郭琪 胡凤玉 唐小平 李凌华[1] 廖宝林 何浩岚 LIU Bo;LI Wen;ZHAO Han;FENG Li⁃zhi;GUO Qi;HU Feng⁃yu;TANG Xiao⁃ping;LI Ling⁃hua;LIAO Bao⁃lin;HE Hao⁃lan(Center of Infectious Disease,Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou,Guangdong 510060;Nuclear Medicine,Affiliated Cancer Hospital and Institution of Guangzhou Medical University,Guangzhou,Guangdong 510000;Laboratory of Virology,Beijing Key Laboratory of Etiology of Viral Diseases in Children,Capital Institute of Pediatrics,Beijing 100020;Guangzhou Institute of Infectious Disease,Guangzhou,Guangdong 510060,China)

机构地区：[1]广州医科大学附属市八医院感染病中心,广东广州510060 [2]广州医科大学附属肿瘤医院核医学科,广东广州510000 [3]首都儿科研究所病毒学研究室,儿童病毒病原学北京重点实验室,北京100020 [4]广州市传染病研究所,广东广州510060

出　　处：《热带医学杂志》2022年第8期1064-1068,1073,共6页Journal of Tropical Medicine

基　　金：“十三五”艾滋病和病毒性肝炎等重大传染病防治科技重大专项(2017ZX10202102-004-001);广州地区艾滋病防治科普知识培训项目(2012KP087)

摘　　要：目的总结HIV-1阳性弓形虫脑病患者的临床特征,为临床诊治提供参考。方法回顾性分析2012年1月-2021年8月期间在广州医科大学附属市八医院感染病中心住院并诊断为HIV-1阳性弓形虫脑病患者的临床资料。收集入组患者临床症状及体征、细胞免疫水平检测、感染性指标(如常规细菌和结核菌、真菌、HIV-1、巨细胞病毒、EB病毒等)、弓形虫相关检测、脑脊液相关检测及影像学检查资料。结果共纳入34例患者,88.2%患者有明显神经系统症状,患者平均年龄38.0(28.0~46.0)岁,CD4^(+)T计数为70.0(13.0~148.0)个/μL。血清弓形虫抗体阳性率76.9%(20/26),脑脊液弓形虫抗体阳性率61.9%(13/21),两者差异无统计学意义(χ^(2)=1.253,P=0.263),血清/脑脊液弓形虫抗体阳性率82.1%(23/28),脑脊液细胞数为9.0(3.5~21.0)×10^(6)/L,脑脊液细胞数升高率64.7%,脑脊液蛋白定量为869.9(680.5~1413.6)mg/L,脑脊液蛋白升高率91.2%。所有患者治疗前均接受头颅CT/MRI检查,31例为增强扫描,3例为普通平扫,影像学提示6例(17.6%)患者伴有脑疝,31例(91.2%)患者颅内病变为多发病灶,31例(91.2%)患者颅内病灶累及大脑,14例(41.2%)患者颅内病灶累及小脑,8例(23.5%)患者颅内病灶累及脑干,4例(11.8%)患者颅内病灶累及间脑。28例(82.4%)患者颅内病灶CT/MRI增强后有环形强化或呈“靶征”,27例(79.4%)患者颅内病灶周围有水肿,24例(70.6%)患者颅内病灶有占位效应,20例(58.8%)患者颅内病灶呈结节状,17例(50.0%)患者颅内病灶呈斑片状,16例(47.1%)患者颅内病灶呈片状,4例(11.8%)患者颅内病灶呈斑点状。91.2%患者在抗HIV治疗前发病,91.2%的患者发病时CD4^(+)T细胞计数<200个/μL。85.3%患者接受抗弓形虫治疗后治愈或好转。结论HIV-1阳性弓形虫脑病患者多伴有严重免疫缺陷,可通过特异性神经系统症状、实验室与影像学改变综合诊断,经治疗后大多预后良好。Objective To summarize the clinical characteristics of HIV-1 positive toxoplasmic encephalopathy patients and provide reference for clinical diagnosis and treatment.Methods A retrospective Analysis of HIV-1 positive toxoplasmic encephalopathy patients admitted to the Infectious Disease Center of the Eighth Hospital Affiliated to the Guangzhou Medical University from January 2012 to August 2021 was performed.The clinical symptoms and signs,cellular immune level detection,infectious indicators(such as conventional bacteria and tuberculosis bacteria,fungi,HIV-1,cytomegalovirus,EB virus,etc.),T.gondii related testing,cerebrospinal fluid(CSF)related testing and imaging examination data were collected.Results A total of 34 patients were included;of which,88.2%had obvious neurological symptoms.The average age of the patients was 38.0(28.0-46.0)years old.The average CD4^(+)T lymphocyte was 70.0(13.0-148.0)cell/μL.The positive of Toxoplasma gondii antibody was 76.9%(20/26)in serum and 61.9%(13/21)in cerebrospinal fluid;there was no significant statistical difference between them(χ^(2)=1.253,P=0.263).The positive rate of T.gondii antibody in serum or cerebrospinal fluid was 82.1%(23/28);the average number of CSF cells was 9.0(3.5-21.0)×10^(6)/L;the rate of increased CSF cells was 64.7%,the average quantity of CSF protein was 869.9(680.5-1413.6)mg/L;the increase rate of CSF protein was 91.2%.All patients received scull CT/MRI scan before treatment,while 31 received enhanced scan,3 got normal scan.The results indicated that 6 cases(17.6%)with cerebral hernia,31 cases(91.2%)with multiple intracranial lesions,31patients(91.2%)involving cerebrum,14 patients(41.2%)involving epencephal,8 patients(23.5%)involving brainstem,and 4 patients(11.8%)involving diencephalon.Annular enhancement sign or target sign were shown in 28patients(82.4%)on scull enhanced CT/MRI scan.Moreover,edema around the intracranial lesion were found in 27 patients(79.4%);intracranial occupied lesions were found in 24 patients(70.6%);intracranial nodular le

关 键 词：HIV-1 弓形虫脑病 CD4^(+)T细胞 

分 类 号：R531.8[医药卫生—内科学]