艾滋病合并结核性脑膜炎脑脊液特点分析  

Analysis of cerebrospinal fluid in AIDS patients with tuberculous meningitis

作　　者：陈媛媛[1] 关琦[1] 李虹[1] 李超峰[1] 赵清霞[1] 孙燕[1] 刘春礼[1] 

机构地区：[1]河南省传染病医院(郑州市第六人民医院)感染一科,郑州450015

出　　处：《中国实用神经疾病杂志》2013年第13期3-6,共4页Chinese Journal of Practical Nervous Diseases

摘　　要：目的了解艾滋病合并结核性脑膜炎患者脑脊液特点。方法回顾性分析2012-01—2012-12在我院感染科住院的25例艾滋病合并结核性脑膜炎和在结核科住院的23例结核性脑膜炎患者的临床资料。按照是否感染HIV,将这些患者分为HIV组与非HIV组。比较2组患者临床资料、CSF常规、生化、ADA、TBDNA,外周血γ-干扰素体外释放试验(T-SPOT.TB)。结果艾滋病合并结核性脑膜炎患者与非HIV结核性脑膜炎患者脑脊液压力升高(≥180mmH2O)、白细胞数<500×106个/L、蛋白升高、氯化物下降、葡萄糖下降、ADA升高、TBDNA阳性率分别为88%和86.96%,92%和95.65%,92%和91.30%,72%和73.91%,60%和60.57%,56%和60.87%,和58.33%和60%;外周血γ-干扰素体外释放试验(T-SPOT.TB)阳性率分别为90%和80%,以上率的比较HIV组与非HIV组差异无统计学意义。2组间以上指标平均值比较:HIV组患者脑脊液白细胞数和TBDNA定量均显著低于非HIV组患者(P=0.002,P=0.011);HIV组患者外周血T-SPOT.TB平均值显著低于非HIV组(P=0.027)。HIV组CD4水平低于200cells/μL的患者占80%。结论结核性脑膜炎是艾滋病晚期的中枢神经系统机会性感染之一。有发热、头痛、恶心、呕吐、颈强直、意识障碍等临床表现。脑脊液压力升高,白细胞数轻、中度升高,蛋白升高,葡萄糖及氯化物降低,ADA升高的特点。外周血T-SPOT.TB阳性率高。与非HIV结核性脑膜炎患者相比脑脊液中白细胞及TBDNA定量平均值较低。Objective To investigate the characteristics of the cerebrospinal fluid in AIDS patients with tuberculous meningitis.Methods The clinical data of 25 AIDS patients with tuberculous meningitis and 23 patients with tuberculous meningitis hospitalized in Zhengzhou No.6 People＇s Hospital from Jan.2012 to Dec.2012 were collected and analyzed retrospectively.All patients were divided into HIV group and non-HIV group according to whether or not infected with HIV.The clinical features of patients,results of laboratory tests of CSF（routine tests,biochemical tests,ADA,TBDNA,etc.） and peripheral blood T-SPOT.TB were analyzed and compared between two groups.Results The two groups had the following biochemical characteristics： intracranial pressure ≥180mmH2O,CSF white blood cell count500×106/L,increase of total protein and ADA,and decline of glucose and chloride level.TBDNA in HIV group and non-HIV group were 88% and 86.96%,92% and 95.65%,92% and 91.30%,72% and 73.91%,60% and 60.57%,56% and 60.87%,58.33% and 60%,respectively.The positive rate of peripheral blood T-SPOT.TB in both groups were 90% and 80%,respectively.The above indexes were no statistical difference between two groups.CSF white blood cell count,TBDNA and peripheral blood T-SPOT.TB value in HIV group were significantly lower than these in non-HIV group（P=0.002,P=0.011 and P=0.027,respectively） 80% patients in HIV group had the lower count of CD4＋T cell（200cells/μL）.Conclusion Tuberculous meningitis is one of common-terminally CNS opportunistic infections in AIDS patients and has some clinical manifestations,such as fever,headache,nausea,vomiting,stiff neck and so on.The cerebrospinal fluid in these patients has the following features： the increase of intracranial pressure,total protein and peripheral blood T-SPOT.TB positive rate,the mild increase of CSF white blood cell and,and the decrease of glucose,chloride and ADA.The mean of white blood cell and TBDNA of CSF in HIV tuberculous meningitis patients is lower than that in non-HIV tubercu

关 键 词：艾滋病 结核 脑脊髓液 

分 类 号：R529.3[医药卫生—内科学] R512.91[医药卫生—临床医学]