隐球菌性脑膜炎患者临床特点及其Th1/Th2免疫应答系统分析  

Clinical characteristics and Th1/Th2 immune response system of patients with cryptococcal meningitis

作　　者：徐苗燕 盛吉芳[1] XU Miaoyan;SHENG Jifang(The First Affiliated Hospital of Zhejiang University,Hangzhou,Zhejiang 310003,China)

机构地区：[1]浙江大学附属第一医院,浙江杭州310000

出　　处：《中国微生态学杂志》2024年第10期1207-1211,共5页Chinese Journal of Microecology

摘　　要：目的观察隐球菌性脑膜炎(cryptococcal meningitis,CM)患者临床特点,了解隐球菌感染过程中的免疫反应,为该病治疗策略的改进提供参考。方法回顾性收集我院2016年1月至2018年5月收治的75例CM患者(CM组)相关临床表现、基础病情和预后情况。选取同期70例无中枢神经系统感染的患者作为对照组。所有患者在入院时接受脑脊液(CSF)检查,记录CSF中IFN-γ、TNF-α、IL-10水平,分析Th1/Th2免疫应答的特征,分析两组之间以上指标的差异。结果CM组患者以男性多见,年龄为(58.62±11.25)岁;其中73例(97.33%)存在基础疾病;临床症状以头痛发热、恶心呕吐为主;隐球菌血培养阳性14例,脑室分流13例;患者药物不良反应主要表现为低钾、肾功能异常;预后良好69例(92.00%)、病情恶化5例(6.67%)、死亡1例(1.33%)。CM组患者IL-10、IFN-γ、TNF-α水平均显著高于对照组(t=6.292、3.649、4.477,均P<0.001)。结论CM患者好发于男性、老年患者,主要症状为头痛发热、恶心呕吐。CM患者多伴有基础疾病,同时Th1/Th2免疫应答系统失衡与CM发生发展相关,可将CSF中IFN-γ、TNF-α、IL-10水平作为监测指标。Objective To observe the clinical characteristics of patients with cryptococcal meningitis(CM),understanding the immune response in cryptococcal infection and refining the treatment strategies.Methods A total of 75 patients with CM admitted to our hospital from January 2016 to May 2018 were enrolled and their clinical manifestations,basic conditions and prognoses retrospectively analyzed.Seventy patients without CM during the same period were enrolled as a control group.All the patients underwent cerebrospinal fluid(CSF)examination upon admission,with levels of interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α)and interleukin-10(IL-10)recorded.The characteristics of helper T lymphocyte subset(Th1/Th2)immune responses were analyzed.The differences in indicator levels between the two groups were analyzed.Results Most patients in CM group were male with an average age of 58.62±11.25.Among the patients,73(97.33%)had underlying conditions.The primary clinical symptoms included headache,fever,nausea,and vomiting.Fourteen cases were tested positive for cryptococcal blood culture,and 13 required ventricular shunts.Adverse drug reactions were mainly hypokalemia and renal dysfunction.Post-treatment outcomes at discharge showed that 69 cases(92.00%)had a favorable prognosis,5 cases(6.67%)had an unfavorable prognosis,and 1 case(1.33%)of death was reported.The CM group exhibited higher levels of IL-10,IFN-γand TNF-αcompared to the control group(t=6.292,3.649,4.477;all P<0.001).Conclusion CM predominantly affects males and the elderlies,with primary symptoms including headache,fever,nausea,and vomiting.Patients with cryptococcal meningitis often have underlying comorbidities,and the imbalance of Th1/Th2 immune response system is related to the occurrence and development of CM.The levels of IFN-γ,TNF-αand IL-10 in CSF can be used as monitoring indicators.

关 键 词：隐球菌性脑膜炎 临床特点 辅助性T淋巴细胞亚群 干扰素-Γ 肿瘤坏死因子-Α 白细胞介素-10 

分 类 号：R446[医药卫生—诊断学]