非人类免疫缺陷病毒相关隐球菌性脑膜炎患者55例临床特征分析  

Clinical features of 55 patients with non-human immunodeficiency virus-associated cryptococcal meningitis

作　　者：林慧珍 张蝶 刘曾晶 黄晓群[4] 黎春婷 方盛 李玲 黄梅艳 黄程 胡艳玲 LIN Huizhen;ZHANG Die;LIU Zengjing;Huang Xiaoqun;LI Chunting;FANG Sheng;LI Ling;HUANG Meiyan;HUANG Cheng;HU Yanling(Department of Microbiology,School of Basic Medical Sciences,Guangxi Medical University/Department of Clinical Laboratory,Wuming Hospital of Guangxi Medical University,Nanning 530199,China;Guangxi Collaborative Innovation Centre for Biomedicine,Guangxi Medical University,Nanning 530022,China;Department of Medical Quality Management,The Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou 545000,Guangxi Zhuang Autonomous Region,China;Department of Clinical Laboratory,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530011,China;Department of Clinical Laboratory,Pingnan People's Hospital,Guigang 537300,Guangxi Zhuang Autonomous Region,China;Department of Critical Care Medicine,Ningming People's Hospital,Chongzuo 532500,Guangxi Zhuang Autonomous Region,China;Department of Clinical Laboratory,Jingxi People's Hospital,Jingxi 533800,Guangxi Zhuang Autonomous Region,China;Department of Clinical Laboratory,The People's Hospital of Shanglin,Nanning 530500,China;Department of Clinical Laboratory,The People's Hospital of DuAn Yao Autonomous County,Hechi 530700,Guangxi Zhuang Autonomous Region,China;Life Sciences Institute,Guangxi Medical University,Nanning 530022,China)

机构地区：[1]广西医科大学基础医学院微生物教研室/广西医科大学附属武鸣医院检验科,南宁530199 [2]广西医科大学广西生物医药协同创新中心,南宁530022 [3]广西医科大学第四附属医院医疗质量管理科,广西柳州545000 [4]广西中医药大学附属瑞康医院检验科,南宁530011 [5]广西平南县人民医院检验科,广西贵港537300 [6]广西宁明县人民医院重症医学科,广西崇左532500 [7]广西靖西市人民医院检验科,广西靖西533800 [8]广西上林县人民医院检验科,南宁530500 [9]广西都安瑶族自治县人民医院检验科,广西河池530700 [10]广西医科大学生命科学研究院,南宁530022

出　　处：《数理医药学杂志》2024年第6期462-469,共8页Journal of Mathematical Medicine

基　　金：广西重点研发计划项目(桂科AB22035027)。

摘　　要：目的分析55例非人类免疫缺陷病毒(human immunodeficiency virus,HIV)相关隐球菌性脑膜炎(cryptococcal meningitis,CM)患者的临床特征,为该病早期临床诊断提供科学依据。方法回顾性分析2004年1月至2023年10月广西医科大学附属武鸣医院及其他五家基层医院实验室诊断为非HIV相关CM患者的电子病历资料,分析其既往史、首发临床特征、实验室检查、影像学检查等。结果55例非HIV相关CM患者中,男性27例(49.1%),中位年龄为57岁(43,67),40例(72.73%)居住在乡村,32例(58.18%)有基础疾病。头痛为最典型的首发临床症状(76.36%),其次为恶心呕吐(50.91%)、头晕(45.45%)、脑膜刺激征阳性(43.64%)、发热(41.82%)。颅内压升高、脑脊液(cerebrospinal fluid,CSF)白细胞计数升高、CSF蛋白定量检测增高、CSF糖定量检测降低和CSF氯化物定量检测降低分别占73.33%、94.34%、86.00%、68.52%和64.81%。白细胞计数升高占50.91%,中性粒细胞百分比升高占67.27%。影像学检查异常占50.91%,以梗死、异常信号病变和脱髓鞘病变为主。结论非HIV相关CM发病以中老年患者为主,居住环境多在乡村,首发临床特征以头痛、恶心呕吐、头晕、脑膜刺激征阳性和发热为主,颅内压和CSF相关指标大多异常,提高医生对非HIV相关CM的认识有助于患者的早期诊疗。Objective The clinical characteristics of 55 patients with non-human immunodeficiency virus(HIV)-associated cryptococcal meningitis(CM)were analyzed to provide scientific basis for early clinical diagnosis of the disease.Methods The electronic medical records of 55 patients with non-HIV-associated CM diagnosed in Wuming Hospital of Guangxi Medical University and 5 other primary hospitals from January 2004 to October 2023 were retrospectively studied,and their past medical history,first clinical features,laboratory examination and imaging examination were analyzed.Results Among 55 patients with non-HIV-associated CM,27 were males(49.1%),and the median age was 57 years(43,67).40 patients(72.73%)lived in rural areas,32 patients(58.18%)had underlying diseases.Headache was the most typical initial clinical symptom(76.36%),followed by nausea and vomiting(50.91%),dizziness(45.45%),meningeal irritation(43.64%),and fever(41.82%).The percentage of intracranial pressure increase,cerebrospinal fluid(CSF)white blood cell count increase,CSF protein quantitative detection increase,CSF glucose quantitative detection decrease,and CSF chloride quantitative detection decrease were 73.33%,94.34%,86.00%,68.52%and 64.81%,respectively.The percentage of white blood cells increase and neutrophils increase were 50.91%and 67.27%.Imaging abnormalities accounted for 50.91%,mainly included infarction,abnormal signal lesions and demyelinating lesions.Conclusion Non-HIV-associated CM patients were mainly middle-aged and elderly patients,and the living environment was mainly rural. The first clinical features were headache, followed by nausea and vomiting, dizziness, positive meningeal irritation signs and fever. Most of the intracranial pressure and CSF related indicators were abnormal. Improving doctors' awareness of non-HIV-associated CM would benefit the early diagnosis and treatment of patients groups.

关 键 词：隐球菌性脑膜炎 非人类免疫缺陷病毒 临床特征 实验室检查 早期诊疗 

分 类 号：R73[医药卫生—肿瘤]