人类免疫缺陷病毒阴性隐球菌性脑膜炎患者临床特点和预后评分体系的构建  

The clinical characteristics and construction of prognostic score system in HIV-negative cryptococcal meningitis patients

作　　者：朱明岩 王浩[2] 蔡群 ZHU Mingyan;WANG Hao;CAI Qun(Department of Emergency Diseases,Ninbo Medical Center Lihuili Hospital,Ninbo,Zhejiang 315000,China)

机构地区：[1]宁波市医疗中心李惠利医院急诊科,浙江315000 [2]浙江大学附属第一医院感染科 [3]宁波市医疗中心李惠利医院感染肝病科

出　　处：《中国微生态学杂志》2023年第8期950-954,959,共6页Chinese Journal of Microecology

摘　　要：目的 探究人类免疫缺陷病毒(HIV)阴性隐球菌性脑膜炎患者的临床特点并构建预后评分体系,为该类患者的治疗提供参考。方法 回顾性分析2018年9月至2021年6月在浙江大学附属第一医院就诊的隐球菌性脑膜炎患者的临床信息、治疗方案及预后情况,同时构建CM-AAIC预后评分体系。结果 构建了基于年龄、白蛋白水平、合并感染情况和意识改变情况的新型CM-AAIC预后评分体系。死亡组患者的预后评分显著高于生存组(P<0.001)。采用CM-AAIC评分预测患者1年病死率,受试者工作特征曲线下面积在试验组和验证组的值分别为0.873和0.728;同时发现在患者诱导期的治疗中,不同的治疗方案对患者1年生存率的影响差异无统计学意义(P>0.05)。结论 CM-AAIC评分对HIV阴性隐球菌性脑膜炎患者预后评估具有较高的灵敏度和特异性。此外,积极预防和控制其他感染,关注患者意识改变可能有助于改善该类患者的治疗结果。Objective To explore the clinical characteristics of HIV-negative cryptococcal meningitis(CM)patients and construct a prognostic score system,providing a reference for the treatment.Methods The clinical information,treatment plan and prognosis of patients with CM who were treated in our hospital from September 2018 to June 2021 were retrospectively analyzed.A CM-AAIC prognostic score system was constructed.Results A novel CM-AAIC prognostic score system based on age,albumin level,co-infection condition,and altered consciousness condition was constructed.The prognostic score in the death group was significantly higher than that in the survival group(P<0.001).The values of the area under the experimenter operating characteristic curve in the experiment group and the validation group were 0.873 and 0.728,respectively.Interestingly,during the induction period of the treatment,we found the effects of different treatment regimens on the 1-year survival rate of patients were statistically insignificant.Conclusion The CM-AAIC score has high sensitivity and specificity for prognositc evaluation of HIV-negative CM patients.Furthermore,solid measures for prevention and control of other infections and increasing patient awareness for the disease might help improve clinical outcomes in HIV-negative CM management.

关 键 词：隐球菌性脑膜炎 预后 评分 治疗 

分 类 号：R515[医药卫生—内科学]