获得性免疫缺陷综合征合并隐球菌性脑膜炎患者的临床资料分析  

Clinical characteristics data analysis of patients with acquired immune deficiency syndrome complicated by cryptococcal meningitis

作　　者：李晨 邹俊 陈天成[2] 覃善芳 黄维 潘艳娜 杨利华 于丹 廖万清 LI Chen;ZOU Jun;CHEN Tiancheng;TAN Shanfang;HUANG Wei;PAN Yanna;YANG Lihua;YU Dan;LIAO Wanqing(Neurovascular Center,first affiliated Hospital of Naval Medical University,Shanghai 200433,China;Shanghai Key Laboratory of Molecular Medical Mycology,second affiliated Hospital of Naval Medical University,Shanghai 200003,China;Department of Infectious Disease,Nanning Forth People’s Hospital,Nanning 530002,China;Department of Infectious Disease,Chest Hospital of Guangxi Province,Liuzhou 545005,China;Department of Emergency,Naval Hospital of Eastern Theater,Zhoushan 316000,China;Department of General Practice,second affiliated Hospital of Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第一附属医院脑血管病中心,上海200433 [2]上海市医学真菌分子生物学重点实验室,上海200003 [3]南宁市第四人民医院感染科,南宁530002 [4]广西壮族自治区胸科医院感染科,柳州545005 [5]东部战区海军医院急诊科,舟山316000 [6]海军军医大学第二附属医院全科医学科,上海200003

出　　处：《中国真菌学杂志》2024年第5期446-450,共5页Chinese Journal of Mycology

基　　金：上海市医学真菌分子生物学重点实验室(20DZ2272000)。

摘　　要：目的分析获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)合并隐球菌性脑膜炎(cryptococcal meningitis,CM)患者的临床及护理特点。方法回顾分析南宁市第四人民医院2016年6月—2023年12月AIDS合并CM患者的流行病学资料、临床表现、护理措施、实验室检查及诊疗与预后情况。结果共纳入178例AIDS合并CM感染病例,患者平均年龄(38.85±11.97)岁,男女比例8.37∶1。患者临床症状不典型,以头痛、发热、呕吐等最为常见。确诊依赖于实验室检查,所有确诊患者中165例(92.70%)患者直接镜检阳性,161例(90.45%)患者培养阳性,154例(86.52%)患者隐球菌荚膜多糖(CrAg)检测阳性。除3例患者未经治疗死亡外,其他175例患者的诱导期抗真菌治疗以两性霉素B联合氟胞嘧啶治疗为主。多数死亡患者入院前未进行抗逆转录病毒治疗,且死亡组患者的CD4+T淋巴细胞降低与颅内压升高更为显著。所有患者经个体化护理,在治疗期间未出现护理相关并发症。结论AIDS合并CM感染患者临床症状不典型,患者病死率较高。临床医师及护理人员对此应提高警惕,针对高危疑似病例加强筛查,及早进行系统性抗真菌治疗,以改善患者预后。Objective To analyze the clinical characteristics and nursing measures of patients with acquired immune deficiency syndrome(AIDS)complicated by cryptococcal meningitis(CM).Methods Epidemiological data,clinical manifestations,nursing measures,laboratory examinations,and diagnosis,treatment,and prognosis of AIDS patients complicated by CM in Nanning Fourth People's Hospital from June,2016 to December,2023 were retrospectively analyzed.Results A total of 178 cases of AIDS complicated by CM were included,with an average age of(38.85±11.97)years and a male-to-female ratio of 8.37∶1.Clinical symptoms of the patients were atypical,with headache,fever,and vomiting being the most common.Diagnosis relied on laboratory examinations,with 165 cases(92.70%)positive on direct microscopy,161 cases(90.45%)positive on culture,and 154 cases(86.52%)positive on cryptococcal antigen(CrAg)testing.Except for 3 untreated patients who died,induction phase antifungal therapy in the other 175 patients mainly involved combination therapy with amphotericin B and flucytosine.Most deceased patients did not receive antiretroviral therapy before admission,and the decrease in CD4+T lymphocytes and increased intracranial pressure were more significant in the deceased group.All patients received individualized nursing care,and no nursing-related complications occurred during treatment.Conclusion Patients with AIDS complicated by CM exhibit atypical clinical symptoms and a high mortality rate.Clinical physicians and nursing staff should remain vigilant and strengthen screening for high-risk suspected cases,initiating systematic antifungal therapy early to improve patient prognosis.

关 键 词：获得性免疫缺陷综合征 隐球菌性脑膜炎 个体化护理 

分 类 号：R519.4[医药卫生—内科学]