人类免疫缺陷病毒感染者、非人类免疫缺陷病毒感染者合并隐球菌性脑膜炎临床特征对比分析  

Comparative analysis of clinical characteristics between HIV-positive and HIV-negative patients with cryptococcal meningitis

作　　者：陶燕萍 许序云 尹正元 陈静 章小凡 TAO Yanping;XU Xuyun;YIN Zhengyuan;CHEN Jing;ZHANG Xiaofan(Department of Emergency,The Third People's Hospital of Kunming,650011,China)

机构地区：[1]昆明市第三人民医院急诊科,650011

出　　处：《传染病信息》2025年第2期128-133,共6页Infectious Disease Information

基　　金：2021年度昆明市卫生科研课题立项项目(2021-03-08-0010);云南省卫生健康委临床医学中心2020-2022年建设(202001AF180153)。

摘　　要：目的探讨艾滋病患者、非人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者在合并隐球菌性脑膜炎(cryptococcal meningitis,CM)时的临床特征差异。方法对昆明市第三人民医院2020年1月至2021年6月期间收治的80例CM患者临床资料进行回顾性分析,按照是否合并HIV感染分为HIV感染组(n=50)和非HIV感染组(n=30),对比2组患者的年龄、性别、基础性疾病、风险因素、病程、临床表现及首次入院实验室指标,并比较治疗方法与转归;并对比症状、病程、首次腰穿检查、基础性疾病以及CD4^(+)T细胞计数方面的差异;比较30d病死率和90d病死率。所有患者均随访跟踪1年。结果HIV感染组CD4^(+)T细胞计数低于非HIV感染组(P<0.05);非HIV感染组使用糖皮质激素,合并肝硬化、慢性肾脏疾病、自身免疫性疾病、恶性肿瘤的患者比例均显著高于HIV感染组,差异均具有统计学意义(P均<0.05)。HIV感染组患者发病至确诊时间显著短于非HIV感染组(P<0.05)HIV感染组患者颅内压、脑脊液白细胞、脑脊液葡萄糖水平均低于非HIV感染组,而隐球菌血症发生率、脑脊液培养阳性率高于非HIV感染组,差异均具有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示:CD4^(+)T细胞计数、自身免疫性疾病、颅内压、脑脊液白细胞、脑脊液葡萄糖、脑脊液培养阳性为HIV感染者发生CM的危险因素。(P均<0.05)。HIV感染组30d、90d病死率均高于非HIV感染组,治疗有效率低于非HIV感染组,差异均具有统计学意义(P均<0.05)。结论HIV感染显著影响CM患者临床特征与转归,HIV感染者表现出更为严重的临床症状、较高的死亡率,且免疫抑制程度越重,预后越差。Objective To investigate the clinical characteristics of cryptococcal meningitis(CM)in AIDS patients and non-human-immunodeficiency virus(HIV)infected patients.Methods A retrospective analysis was conducted on 80 CM patients admitted to the Third People's Hospital of Kunming from January 2020 to June 2021.They were divided into an HIV infected group(n=50)and a non HIV infected group(n=30)based on whether they had concurrent HIV infection.The age,gender,underlying diseases,risk factors,disease course,clinical manifestations,and laboratory indicators at the first admission of the 2 groups were compared,and the treatment methods and outcomes were compared;And compare the differences in symptoms,disease course,first lumbar puncture examination,underlying diseases,and CD4^(+)T cell count;Compare the 30 day mortality rate with the 90 day mortality rate.All patients were followed up for 1 year.ResultsThe CD4^(+)T cell count in the HIV infected group was lower than that in the non HIV infected group(P<0.05);The proportion of patients with cirrhosis,chronic kidney disease,autoimmune diseases,and malignant tumors who used glucocorticoids in the non HIV infected group was significantly higher than that in the HIV infected group,and the differences were statistically significant(P<O.05).The time from onset to diagnosis in the HIV infected group was significantly shorter than that in the non HIV infected group(P<0.05);The intracranial pressure,cerebrospinal fluid(CSF)white blood cells,and CSF glucose levels in the HIV infected group were lower than those in the non HIV infected group,while the incidence of cryptococcemia and the positive rate of cerebrospinal fluid culture were higher than those in the non HIV infected group and the dfferences were statistically significant(P<0.05).The results of multiple logistic regression analysis showed that CD4^(+)T cell count,autoimmune diseases,intracranial pressure,cerebrospinal fluid white blood cells,cerebrospinal fluid glucose,and positive cerebrospinal fluid culture were independe

关 键 词：人类免疫缺陷病毒 隐球菌脑膜炎 临床特征 病死率 

分 类 号：R512.91[医药卫生—内科学]