重庆地区149例艾滋病合并新生隐球菌性脑膜脑炎病例的回顾性研究

中国真菌学杂志　 2019, Vol. 14 　Issue (4): 204-209.

重庆地区149例艾滋病合并新生隐球菌性脑膜脑炎病例的回顾性研究

鲁雁秋, 吴玉珊, 邱丹, 陈耀凯

重庆市公共卫生医疗救治中心, 重庆 400036

收稿日期:2018-09-10 出版日期:2019-08-28 发布日期:2019-08-28
通讯作者: 陈耀凯,E-mail:yaokaichen@hotmail.com E-mail:yaokaichen@hotmail.com
作者简介:鲁雁秋,女(汉族),本科,住院医师.E-mail:doctorlu828@163.com
基金资助:
“十三五”国家科技重大专项课题（2018ZX10302104，2017ZX10205501-001-008）；重庆市卫生计生委医学科研计划项目（2011-2-390）

Retrospective analysis of 149 cases of cryptococcal meningitis with AIDS

LU Yan-qiu, WU Yu-shan, QIU Dan, CHEN Yao-kai

Chongqing Public Health Medical Center, Chongqing 400036, China

Received:2018-09-10 Online:2019-08-28 Published:2019-08-28

摘要/Abstract

摘要：

目的本研究旨在描述重庆地区住院患者艾滋病合并新生隐球菌性脑膜炎诊断病例的人口学特征、实验室检查概况、治疗方案以及预后影响因素。方法收集整理2016年1月~2018年1月重庆市公共卫生医疗救治中心收治的艾滋病合并隐球菌脑膜炎的病例资料。诊断方法以脑脊液隐球菌培养作为参照进行评估。结果共纳入149个病例。患者的平均年龄为42.54±12.94岁，发病以男性（72.5%）为主，CD4⁺T淋巴细胞计数中位数为24.00个/μL，有84.50%的患者HIV RNA ≥ 4 lg拷贝/mL；脑脊液隐球菌墨汁染色的阳性率为98.00%，灵敏度96.80%，特异度100.00%，诊断符合率为61.1%，隐球菌培养的阳性率为63.10%；住院患者死亡率为12.08%（18/149）。青年组（18~44岁）、中年组（44~60岁）、体重下降在2 kg以内、抗真菌治疗前初始脑脊液氯化物正常或降低为艾滋病合并新生隐球菌性脑膜炎住院患者院内结局的保护因素，而头痛、意识障碍、乏力、基线CD4⁺T淋巴细胞计数为5~12细胞个数/μL、初始脑压大于250 mm/H₂O为危险因素，其中年龄在18~44岁是艾滋病合并隐脑住院患者的独立保护因素，而意识障碍、乏力为住院患者的两个独立危险因素，差异均有统计学意义。结论艾滋病合并新生隐球菌性脑膜炎的住院患者院内病死率高，临床表现复杂，预后影响因素多，需引起医务工作者的高度重视，加强对该疾病的综合管理。

关键词: 艾滋病, 新生隐球菌性脑膜脑炎, 临床特征, 预后影响因素

Abstract:

Objective To describe the demographic characteristics, laboratory profile, therapeutic and outcome of cases diagnosed as cryptococcal meningitis with AIDS in Chongqing. Methods We analyzed the cryptococcosis cases diagnosed in the Chongqing Public Health Medical Center from January 2016 to January 2018.The diagnosis was confirmed by culture on Sabouraud's dextrose agar and/or by India ink preparation. The diagnosis methods were assessed by using culture as reference. Results A total of 149 cases of cryptococcal meningitis were diagnosed. The mean age of the patients was 42.54±12.94 years, and the male dominated(72.5%).The median CD4⁺ count was 24.00 cells/μL. India ink staining presented positive rate at 98.00%, the sensitivity at 96.80%,the specificity at 100.00%,and the diagnostic coincidence rate at 61.1%.The hospital mortality rate was 12.08% (18/149).Youth (18~44 years) and middle age (44~60 years), weight loss within 2 kg, normal or decreased chloride in cerebrospinal fluid before the initiation of anti-fungal treatment were the protective factors for the hospitalized patients,while the headache, disturbance of consciousness, fatigue, baseline CD4⁺ T cells for the number of 5~12 cells/μL, the initial the brain pressure greater than 250mm/H₂O as risk factors. Age of 18~44 years was the independent protective factor, disturbance of consciousness and fatigue were two independent risk factors for hospitalized patients. The difference was statistically significant. Conclusion The mortality of patients with AIDS combined with cryptococcal meningitis was high, the clinical manifestations were complex, and the prognosis was influenced by many factors, so it was necessary to attach great importance to the medical workers and strengthen the comprehensive management of the disease.

Key words: AIDS, cryptococcal meningitis, clinical features, prognostic factors

中图分类号:

R519.4

鲁雁秋, 吴玉珊, 邱丹, 陈耀凯. 重庆地区149例艾滋病合并新生隐球菌性脑膜脑炎病例的回顾性研究[J]. 中国真菌学杂志, 2019, 14(4): 204-209.

LU Yan-qiu, WU Yu-shan, QIU Dan, CHEN Yao-kai. Retrospective analysis of 149 cases of cryptococcal meningitis with AIDS[J]. Chinese Journal of Mycology, 2019, 14(4): 204-209.

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