以隐球菌性脑膜炎为首发症状的获得性免疫缺陷综合征的临床诊治分析

摘要

Objective To investigate the clinical features and treatment of patients with acquired immunodeficiency syndrome ( AIDS ) with cryptococcal meningitis as the initial symptoms. Methods Clinical data, laboratory and imaging results and treatment of 5 AIDS patients combined with cryptococcal meningitis were retrospectively analyzed. Results 5 AIDS patients combined with cryptococcal meningitis were admitted to the hospital with subacute onset of headache, nausea and fever as the main symptoms. According to the results of blood routine examination, All five patients had increased cerebrospinal pressure and one patient had increased level of protein, and normal level of chloride, 2 patients had total cell number in cerebrospinal fluid > 1 000 ×106/L, All five patients had increased cerebrospinal pressure and one patient had increased level of protein, and normal level of chloride, 2 patients had glucose < 2. 5 mmol/L, and large amount of cryptococcal meningitis can be seen from cerebrospinal fluid smear. Imaging examination showed no abnormalities among the patients. 2 out of the 5 patients were treated by amphoteri-cin B combined with fluconazole or voriconazole and were transferred to other hospitals. 2 cases gave up treatment and one case died from cerebral hernia. Conclusion AIDS patients combined with cryptococcal meningitis usually have headache, nausea and fever as main symptoms. Cerebrospinal fluid smear is the diagnosis basis while imaging examination is of little significance. Combined antifungal therapy is effective for the treatment of the disease. The diagnosis techniques in the hospital should be improved and AIDS education should be well conducted to help prevent the occurrence of infectious diseases.%目的 探讨以隐球菌性脑膜炎为首发症状的获得性免疫缺陷综合征(AIDS)患者的临床特点及诊治情况.方法 对5例AIDS并发隐球菌性脑膜炎患者的临床一般情况、实验室和影像学检查结果及治疗情况进行回顾性分析.结果 5例AIDS并发隐球菌性脑膜炎患者以头痛、恶心呕吐、发热为主要症状入院,亚急性发病.实验室检查血常规白细胞计数均<5.0×109/L,淋巴细胞计数均≤1.0×109/L;2例患者脑脊液中总细胞数>1 000×106/L,5例患者脑脊液压力均增高,1例蛋白质含量增高,氯化物均正常,2例患者葡萄糖<2.5 mmol/L;脑脊液涂片均可见大量隐球菌.影像学检查多数患者未见异常.5例患者中2例采用两性霉素B和氟康唑或伏立康唑联合治疗,症状缓解后转院继续治疗,2例主动放弃治疗,1例因脑疝死亡.结论 AIDS并发隐球菌性脑膜炎患者以头痛、恶心呕吐、发热为主要症状,脑脊液涂片是隐球菌性脑膜炎的直接诊断依据,影像学检查诊断意义不大,采用抗真菌联合治疗效果较好.应提高医院实验室诊断技术水平,做好AIDS宣传教育工作,为减少感染性疾病的发生提供帮助.