结核性脑膜炎混合感染对艾滋病合并弓形虫脑炎患者临床特征及短期预后的影响  

Impact of coexistent cuberculous meningitis on clinical features and short-term prognosis of patients with acquired immunodeficiency syndrome and toxoplasma encephalitis

作　　者：刘敏[1] 吴玉珊 舒伟强 吴昊[2] 陈耀凯[1] LIU Min;WU Yushan;SHU Weiqiang;WU Hao;CHEN Yaokai(Chongqijig Public Health Medical Center,Chongqing 400036,China;Beijing Youan Hospital,Capital University,Beijing 100069)

机构地区：[1]重庆市公共卫生医疗救治中心,重庆400036 [2]首都医科大学附属北京佑安医院,北京100069

出　　处：《中国艾滋病性病》2019年第2期132-135,共4页Chinese Journal of Aids & STD

基　　金：十三五"国家科技重大专项(2018ZX10302104-001;2017ZX10202101-002-007);重庆市卫生计生委医学科研项目(2016HBRC008);重庆市卫生计生委医学科研计划项目(2017MSXM119)~~

摘　　要：目的分析结核性脑膜炎混合感染对于艾滋病合并弓形虫脑炎(AIDS/TE)患者临床特征及短期预后的影响。方法回顾性收集AIDS/TE与AIDS合并TE和结核性脑膜炎(AIDS/TE/TBM)患者的临床资料,比较两组病例在症状与体征、实验室检查、头颅影像学表现及短期预后方面的差异。结果共有38例AIDS/TE病例与16例AIDS/TE/TBM病例纳入本研究,两组病例在年龄、性别、CD4+T淋巴细胞计数、弓形虫抗体阳性率等方面无明显差异;两组病例症状体征、实验室检查结果、影像学检查结果及住院结局基本相似,但AIDS/TE/TBM患者临床表现重于AIDS/TE患者,且AIDS/TE/TBM病例肢体活动障碍、大小便失禁和脑膜刺激征阳性发生率明显高于AIDS/TE患者(P<0.05),脑脊液微量蛋白水平也显著高于AIDS/TE病例(P<0.05)。结论晚期艾滋病患者发生TE与TBM混合感染较为常见,肢体活动障碍、大小便失禁、脑膜刺激征阳性及脑脊液微量蛋白定量明显增高可作为鉴别诊断线索。Objective To investigate the potential impact of coexistent tuberculous meningitis(TBM)on the clinical features and short-term prognosis of patients with acquired immunodeficiency syndrome(AIDS)and toxo-plasma encephalitis(AIDS/TE).Methods Clinical data were retrospectively collected from the patients withAIDS/TE combined with AIDS,toxoplasma encephalitis and tuberculous meningitis(AIDS/TE/TBM)to comparethe differences of symptoms and signs,laboratory examination,head imaging and short-term prognosis between thetwo groups.Results A total of 38 cases of AIDS/TE and 16 cases of AIDS/TE/TBM were included in this study.There was no significant difference between the two groups in age,sex,CD4+T cell count and positive rate of toxo-plasma gondii antibody.The symptoms,signs,laboratory examination results,imaging findings and hospital out-comes were similar between the two groups.However,the clinical manifestations of AIDS/TE/TBM patients weremore severe than those of AIDS/TE patients,and the positive rates of limb mobility disorder,fecal incontinence andmeningeal irritation sign in AIDS/TE/TBM patients were significantly higher than those in AIDS/TE patients(P<0.05).The level of trace protein in CSF was also significantly higher than that in AIDS/TE patients(P<0.05).Conclusion TE and TBM mixed infection is commonin patients with advanced AIDS.Limb movementdisorder,fecal incontinence,meningeal irritation signand positive cerebrospinal fluid trace protein can significantly increase as diagnostic clues.

关 键 词：艾滋病 弓形虫脑炎 结核性脑膜炎 临床特征 回顾性研究 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]