脑室-腹腔分流术治疗艾滋病合并新型隐球菌性脑膜炎的临床疗效  

Clinical efficacy of ventriculo-peritoneal shunt in the treatment of acquired immunodeficiency syndrome complicated with cryptococcal neoformans meningitis

作　　者：柯迎春[1] 林梓梁 李凌华[1] 蔡卫平[1] 潘能浪 陈谐捷[1] Ke Yingchun;Lin Ziliang;Li Linghua;Cai Weiping;Pan Nenglang;Chen Xiejie(Department of Infectious Diseases,Guangzhou Eighth People′s Hospital,Guangzhou Medical University,Guangzhou 510060,China)

机构地区：[1]广州医科大学附属市八医院感染科,广州510060

出　　处：《中华传染病杂志》2022年第5期270-274,共5页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金(82072265);广州市基础研究计划民生科技专题(202002020005)。

摘　　要：目的探讨脑室-腹腔分流术(ventriculo-peritoneal shunt, VPS)治疗艾滋病合并新型隐球菌性脑膜炎(cryptococcal neoformans meningitis, CNM)患者的临床疗效。方法纳入2015年1月至2020年6月广州医科大学附属市八医院感染科住院治疗的艾滋病合并CNM患者, 分为VPS组和常规治疗组。回顾性分析患者入院时脑膜炎相关症状和体征、脑脊液压力、脑脊液常规检查、脑脊液墨汁涂片染色、隐球菌培养结果, 以及隐球菌培养转阴时间等资料, 比较2组患者治疗6周和48周时的疗效。统计学分析采用两独立样本t检验或χ^(2)检验。结果 66例艾滋病合并CNM患者中, VPS组26例, 年龄为(35.7±11.9)岁, 11例(42.3%)入院时脑脊液压力>330 mmH2O(1 mmH2O=0.009 8 kPa), 25例(96.2%)墨汁染色阳性, 20例(76.9%)脑脊液新型隐球菌培养阳性;常规治疗组40例, 年龄为(38.9±12.9)岁, 15例(37.5%)脑脊液压力>330 mmH2O, 32例(80.0%)墨汁染色阳性, 31例(77.5%)脑脊液新型隐球菌培养阳性, 两组患者年龄、脑脊液压力>330 mmH2O者所占比例、墨汁染色阳性率、脑脊液培养阳性率之间差异均无统计学意义(t=-1.02,χ^(2)=0.15、3.49、0.00, 均P>0.050)。所有患者入院后均给予抗真菌治疗、降颅压、营养支持和对症治疗, VPS组内科保守治疗欠佳后行VPS。治疗6周时, VPS组脑脊液压力恢复正常率为57.7%(15/26), 部分缓解率为73.1%(19/26), 分别高于常规治疗组的31.0%(9/29)和47.5%(19/40), 差异均有统计学意义(χ^(2)=3.96、4.22, 均P<0.050)。治疗48周时, VPS组脑脊液压力恢复正常率为92.3%(24/26), 脑脊液隐球菌培养转阴率为100.0%(20/20), 完全缓解率为46.2%(12/26), 分别高于常规治疗组的37.9%(11/29)、67.7%(21/31)和20.0%(8/40), 差异均有统计学意义(χ^(2)=17.52、8.03、5.10, 均P<0.050)。VPS组完全或部分缓解者22例, 无效4例, 无一例死亡;常规治疗组完全或部分缓解者23例, 无效12例, 死亡5例, VPS组无效或死亡�Objective To investigate the clinical efficacy of ventriculo-peritoneal shunt(VPS)in acquired immunodeficiency syndrome(AIDS)patients with cryptococcal neoformans meningitis(CNM).Methods Patients with AIDS and CNM who were hospitalized in Guangzhou Eighth People′s Hospital,Guangzhou Medical University from January 2015 to June 2020 were included and divided into VPS group and conventional treatment group.The data including symptoms and signs of meningitis,cerebrospinal fluid(CSF)pressure,CSF routine examination,ink staining,Cryptococcus culture and Cryptococcus culture negative time were obtained,and the clinical efficacy compared between the two groups after six and 48 weeks of treatment.Two independent samples t test or chi-square test was used for statistical analysis.Results Among 66 AIDS patients with CNM,26 cases in VPS group were(35.7±11.9)years,and 11 cases(42.3%)had CSF pressure>330 mmH2O(1 mmH2O=0.0098 kPa)at admission,25 cases(96.2%)were positive for ink staining,and 20 cases(76.9%)had positive culture of Cryptococcus neoformans in CSF.There were 40 cases in the conventional treatment group with age of(38.9±12.9)years,15 cases(37.5%)had CSF pressure>330 mmH2O,32 cases(80.0%)were positive for ink staining,and 31 cases(77.5%)were positive for culture of Cryptococcus neoformans in CSF.There were no significant differences of age,the proportion of patients with CSF pressure>330 mmH2O,positive rate of ink staining,positive rate of Cryptococcus culture between the two groups(t=-1.02,χ^(2)=0.15,3.49 and 0.00,respectively;all P>0.050).All patients were administrated with antifungal treatment,decreasing CSF pressure treatment,nutritional support and symptomatic treatment after admission.VPS was performed in patients with poor responses after medical conservative treatment in VPS group.At week six of treatment,the recovery rate of CSF pressure in VPS group was 57.7%(15/26),and the partial remission rate was 73.1%(19/26),which were both higher than those in conventional treatment group(31.0%(9/29)and 47.5%(1

关 键 词：获得性免疫缺陷综合征 脑室-腹膜分流术 新型隐球菌性脑膜炎 疗效 

分 类 号：R512.91[医药卫生—内科学] R651.1[医药卫生—临床医学]