艾滋病合并新生隐球菌性脑膜炎41例临床分析  

Clinical analysis of 41 cases of AIDS patients with cryptococcal meningitis

作　　者：郑璐 陈绛青[1] ZHENG Lu;CHEN Jiang-qing(Department of Infection,Nanchang Ninth Hospital,Nanchang 330002,China)

机构地区：[1]南昌市第九医院感染科,江西南昌330002

出　　处：《临床皮肤科杂志》2020年第6期339-341,共3页Journal of Clinical Dermatology

摘　　要：目的:探讨艾滋病合并新生隐球菌性脑膜炎患者的临床特征及疗效。方法:回顾性分析2011年4月——2018年6月该院收治的41例艾滋病合并新生隐球菌性脑膜炎患者的临床特点、实验室和辅助检查及疗效等。结果:所有患者中临床表现为发热者25例(61.0%),头痛者23例(56.1%),恶心呕吐者8例(19.5%)及颈项强直者29例(70.7%)。CD4^+T淋巴细胞计数<100×10^6个/L者40例(97.6%);脑脊液压力>180 mmH2O者34例(82.9%),脑脊液墨汁染色阳性者34例(82.9%),脑脊液培养示新生隐球菌阳性者28例(68.3%),6例脑脊液隐球菌荚膜多糖抗原检查均阳性(100%),合并新生隐球菌败血症者23例(56.1%);头颅影像学检查异常者12例(29.3%)。经规范化抗隐球菌治疗,有效率为70.7%(29例),病死率为29.3%(12例),其中复发率为2.4%(1例)。结论:对疑似艾滋病合并新生隐球菌性脑膜炎感染患者应及时行腰椎穿刺术、脑脊液病原学检测及隐球菌荚膜多糖抗原检查,对疑似患者的早期诊断和治疗是降低新生隐球菌性脑膜炎病死率的关键。Objective:To investigate the clinical characteristics and efficacy of anti-Cryptococcus therapy in AIDS patients complicated with cryptococcal meningitis.Methods:A retrospective analysis was made on the clinical characteristics,laboratory and auxiliary examinations,as well as efficacy of anti-Cryptococcus therapy in 41 patients with AIDS and cryptococcal meningitis who were admitted to their hospital between April 2011 and June 2018.Results:Among those 41 patients whose cases they reviewed,there were 25 patients(61.0%)with fever,23 patients(56.1%)with headache,8 patients(19.5%)with nausea and vomiting,and 29 patients(70.7%)with cervical rigidity.Forty patients(97.6%)had the CD4^+T lymphocyte count less than 100×10^6/L,and 34 patients(82.9%)showed CSF pressure grater than 180 mm H2O.The ink staining of cerebrospinal fluid was positive in 34 patients(82.9%).Culture for Cryptococcus neoformans was positive in 28 patients(68.3%).The cryptococcal capsular polysaccharide antigen test of cerebrospinal fluid was positive in 6 patients(100%).Cryptococcus neoformans sepsis was found in 23 cases(56.1%).There were 12 patients(29.3%)with abnormal cranial imaging examination.After standardized anti-Cryptococcus therapy,the effective rate was 70.7%(29 cases),the fatality rate was 29.3%(12 cases),and the recurrence rate was 2.4%(1 case).Conclusion:Lumbar puncture,examination of cerebrospinal fluid for pathogen and cryptococcal capsular polysaccharide antigen test should be performed on patients who are suspicious for AIDS and associated cryptococcal meningitis.Early diagnosis and treatment of suspected patients is the key to reduce mortality associated with AIDSrelated cryptococcal meningitis.

关 键 词：艾滋病 新生隐球菌性脑膜炎 隐球菌荚膜多糖抗原 两性霉素B 

分 类 号：R519.4[医药卫生—内科学] R512.91[医药卫生—临床医学]