获得性免疫缺陷综合征合并隐球菌性脑膜炎预后影响因素分析  

Analysis of prognostic factors of acquired immunodeficiency syndrome complicated with cryptococcal meningitis

作　　者：涂文瑶 何娟 龙海 吴君 梁跃东 TU Wenyao;HE Juan;LONG Hai;WU Jun;LIANG Yuedong(Department of Infectious Diseases,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of AIDS,Guiyang Public Health Treatment Center,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院感染科,贵州贵阳550004 [2]贵阳市公共卫生救治中心艾滋病科,贵州贵阳550004

出　　处：《贵州医科大学学报》2021年第4期440-446,共7页Journal of Guizhou Medical University

基　　金：贵州省卫计委科学技术基金项目(gzwjkj2018-1-077)。

摘　　要：目的分析获得性免疫缺陷综合症(AIDS)合并隐球菌性脑膜炎(CM)患者预后影响因素。方法137例AIDS合并CM患者根据随访结束时的生存状况分为生存组及死亡组,采用单因素方差分析两组患者的年龄、性别、影像学检查(胸部CT、头颅CT或MRI)、临床症状(头痛、发热、呕吐及意识障碍)、血常规、C反应蛋白、红细胞沉降率、降钙素原、血(1,3)-β-D葡聚糖、细菌内毒素、血液隐球菌抗原(CrAg)阳性率、CD4+T淋巴细胞、HIV病毒载量、脑脊液氯化物、脑脊液葡萄糖及脑脊液蛋白的差异,将有差异的因素(P<0.05)纳入COX比例风险回归模型,确定AIDS合并CM的独立预后影响因素;采用Kaplan-Meier法测定患者生存率,Log-rank检验各影响因素差异的显著性。结果137例AIDS合并CM患者中,生存组111例、死亡组26例,单因素分析显示患者年龄、CD4+T淋巴细胞、HIV病毒载量、血(1,3)-β-D葡聚糖及血液CrAg阳性是AIDS合并CM患者预后影响因素(P<0.05);多因素COX回归分析显示患者年龄(HR=4.375,95%CI为1.855~10.319,P=0.001)、CD4+T淋巴细胞(HR=4.110,95%CI为2.351~12.553,P=0.013)、HIV病毒载量(HR=5.040,95%CI为1.119~22.699,P=0.035)及血液CrAg阳性(HR=8.135,95%CI为2.353~26.113,P=0.001)是AIDS合并CM独立预后影响因素;Log-rank检验及Kaplan-Meier生存曲线图显示患者年龄≥50岁、CD4+T淋巴细胞<50个/μL、HIV病毒载量≥1×107拷贝/L及血液CrAg阳性可导致AIDS合并CM患者生存率明显下降(P<0.05)。结论年龄、CD4+T淋巴细胞、HIV病毒载量、及血液CrAg阳性是影响AIDS合并CM独立预后影响因素。Objective To analyze the prognostic factors of acquired immune deficiency syndrome(AIDS)complicated with cryptococcal meningitis(CM),and provides theoretical basis for the prevention and treatment of AIDS patients complicated with CM.Methods The clinical medical records of 137 cases of AIDS patients with CM were collected and analyzed,univariate variance analysis was used to analyze the differences of age,sex,imaging examination(chest CT,head CT or MRI),clinical symptoms(headache,fever,vomiting and disturbance of consciousness),blood routine,C-reactive protein,ESR,procalcitonin,blood(1,3)-β-D glucan,bacterial endotoxin,detection of cryptococcus antigen in blood,CD4-positive T-lymphocytes,HIV viral load,CSF chloride,CSF glucose and CSF protein between the two groups,Univariate analysis were statistically significant factors(P<0.05)into COX proportional risk regression model to analyze the influencing factors of independent prognosis,Kaplan-Meier method was used to determine the survival rate of patients,and Log-rank was used to test the significance of the difference of each influencing factor.Results 137 newly diagnosed AIDS patients with CM were divided into survival group(111 cases)and death group(26 cases).Univariate analysis showed that age,CD4-positive T-lymphocytes,HIV viral load,blood(1,3)-β-D glucan,blood CrAg positive were the prognostic factors of AIDS patients with CM,and the difference was statistically significant(P<0.05),multivariate COX regression analysis showed that age(HR=4.375,95%CI was 1.855-10.319,P=0.001),CD4-positive T-lymphocytes(HR=4.110,95%CI was 2.351-12.553,P=0.013),HIV viral load(HR=5.040,95%CI was 1.119-22.699,P=0.035),blood CrAg positive(HR=8.135,95%CI was 2.353-26.113,P=0.001)are prognostic factors for AIDS patients complicated with CM(P<0.05).The Log-rank test and Kaplan-Meier survival curveshowed that age≥50 years,CD4-positive T-lymphocytes<50 cells/μL,HIV viral load≥1×107 copy/L and cryptococcus antigen positive in blood could significantly reduce the survival rate of AI

关 键 词：获得性免疫缺陷综合征 脑膜炎 隐球菌性 预后影响因素 年龄 CD4+T淋巴细胞 HIV病毒载量 血(1 3)-β-D葡聚糖 隐球菌抗原 

分 类 号：R512.91[医药卫生—内科学]