艾滋病合并结核性脑膜炎和新型隐球菌性脑膜炎的临床特征比较  

Comparison of clinical features of tuberculous meningitis and cryptococcus neoformans meningitis in patients with acquired immunodeficiency syndrome

作　　者：柯迎春[1] 陈景良 蔡卫平[1] 郭朋乐 潘能浪 陈谐捷[1] 李凌华[1] Ke Yingchun;Chen Jingliang;Cai Weiping;Guo Pengle;Pan Nenglang;Chen Xiejie;Li Linghud(Department of Infectious Diseases,Guangzhou Eighth People′s Hospital,Guangzhou Medical University,Guangzhou 510440,China)

机构地区：[1]广州医科大学附属市八医院感染病中心,广州1510440

出　　处：《中华传染病杂志》2024年第2期65-70,共6页Chinese Journal of Infectious Diseases

基　　金：广东省中医药局科研项目(20232140);广州市科技计划项目(2023A03J0794)。

摘　　要：目的探索艾滋病(AIDS)合并结核性脑膜炎(TBM)和新型隐球菌性脑膜炎(CNM)的临床特征,为临床早期鉴别诊断提供依据。方法纳入2011年1月至2022年2月在广州医科大学附属市八医院住院且出院分别诊断为合并TBM和CNM的AIDS患者,回顾性分析21例AIDS合并TBM(TBM组)和54例AIDS合并CNM患者(CNM组)(均为病原学诊断)的临床特征,包括脑膜炎相关症状和体征,入院时血常规、CD4^(+)T淋巴细胞计数、影像学检查、脑脊液检查等。统计学分析采用独立样本t检验、秩和检验或χ^(2)检验。结果TBM组患者的年龄为(44.6±12.9)岁,大于CNM组患者[(37.6±12.6)岁],差异有统计学意义(t=-2.15,P=0.035)。CNM组分别有48例(88.89%)和7例(12.96%)出现头痛和意识障碍,与TBM组[13例(61.90%)和9例(42.86%)]的差异均有统计学意义(χ^(2)=7.25,P=0.007;χ^(2)=8.05,P=0.005)。CNM组白细胞计数减少的患者比例为27.78%(15/54),血小板计数减少的患者比例为16.67%(9/54),分别高于TBM组[4.76%(1/21)和0(0/21)],差异均有统计学意义(χ^(2)=4.77,P=0.029;χ^(2)=3.98,P=0.042)。TBM组CD4^(+)T淋巴细胞计数为74.0(92.0)/μL,高于CNM组的19.5(56.5)/μL,差异有统计学意义(Z=-2.87,P=0.009)。CNM组分别有46例(85.19%)和24例(44.44%)患者脑脊液压力>180 mmH_(2)O(1 mmH_(2)O=0.0098 kPa)和>330 mmH_(2)O,高于TBM组[7例(33.33%)和4例(19.05%)],差异均有统计学意义(χ^(2)=19.61,P<0.001;χ^(2)=4.17,P=0.041)。TBM组脑脊液白细胞数>200×10^(6)/L的患者比例为52.38%(11/21),高于CNM组[1.85%(1/54)],差异有统计学意义(χ^(2)=27.23,P<0.001)。TBM组脑脊液白细胞数、蛋白质、腺苷脱氨酶高于CNM组[200.00(579.50)×10^(6)/L比17.50(66.25)×10^(6)/L,1863(2858)mg/L比672(513)mg/L,6.60(8.55)U/L比1.95(2.60)U/L],脑脊液氯化物低于CNM组[(107.71±8.22)mmol/L比(115.99±6.55)mmol/L],差异均有统计学意义(Z=4.11,P<0.001;Z=21.23,P=0.008;Z=2.09,P=0.040;t=4.57,P<0.001)。TBM组和CNM组脑脊液葡萄糖差异无统计学意义[(1.86ObjectiveTo explore the early differential diagnosis method by comparing the clinical characteristics of acquired immunodeficiency syndrome(AIDS)patients complicated with tuberculous meningitis(TBM)and cryptococcus neoformans meningitis(CNM).MethodsThe AIDS patients admitted to Guangzhou Eighth People′s Hospital,Guangzhou Medical University from January 2011 to February 2022 and diagnosed with combined TBM and CNM after discharge respectively were included.A retrospective study was performed to analyze the clinical features of 21 AIDS patients complicated with TBM(TBM group)and 54 AIDS patients with CNM(CNM group)(all cases were confirmed by etiology).The data of meningitis-related symptoms and signs,blood routine test,CD4^(+)T lymphocyte counts,imaging characteristics and cerebrospinal fluid examination at admission were collected and analyzed.Statistical analysis was performed by using independent sample t test,rank sum test or chi-square test.ResultsThe age of patients in the TBM group was(44.6±12.9)years old,which was older than that of patients in the CNM((37.6±12.6)years old),the difference was statistically significant(t=-2.15,P=0.035).Forty-eight cases(88.89%)and seven cases(12.96%)in the CNM group experienced headaches and consciousness disorders respectively,with statistically significant differences compared to those in the TBM group(13 cases(61.90%)and nine cases(42.86%),respectively)(χ^(2)=7.25,P=0.007 andχ^(2)=8.05,P=0.005,respectively).The proportion of leukopenia was 27.78%(15/54),and proportion of thrombocytopenia was 16.67%(9/54)in the CNM group,which were higher than those in the TBM group(4.76%(1/21)and 0(0/21),respectively),and the differences were statistically significant(χ^(2)=4.77,P=0.029 andχ^(2)=3.98,P=0.042,respectively).The CD4^(+)T lymphocyte count in the TBM group was 74.0(92.0)/μL,which was higher than 19.5(56.5)/μL in the CNM group,and the difference was statistically significant(Z=-2.87,P=0.009).The CNM group had 46 cases(85.19%)with cerebrospinal fluid pressure>180 mmH

关 键 词：获得性免疫缺陷综合征 结核 脑膜 新型隐球菌性脑膜炎 临床特征 

分 类 号：R512.91[医药卫生—内科学] R519.4[医药卫生—临床医学] R529.3