人类免疫缺陷病毒抗体阳性与阴性隐球菌脑膜炎患者临床特点分析

摘要

目的分析人类免疫缺陷病毒（ HIV）抗体阳性与阴性隐球菌脑膜炎（隐脑）患者的临床特征、治疗及预后。方法收集该院2006-06～2012-06收治的64例隐脑患者的临床资料，按HIV抗体阳性与阴性分为两组，比较分析两组患者的特点。结果两组患者均主要表现为发热、头痛、呕吐，有脑膜刺激征及颅内压升高，HIV阳性组起病较急，发热较明显，从发病到确诊的平均时间短于HIV阴性组，合并机会性感染多。两组脑脊液检查均主要表现为细胞数和蛋白含量升高，葡萄糖和氯化物含量降低，HIV阳性组脑脊液细胞数明显较阴性组少。两组头颅影像学表现主要为脑膜改变及脑积水，累及脑实质多见于HIV阳性患者。两组患者均予两性霉素B单用或联用抗隐球菌治疗，未抗隐球菌治疗及颅内压越高患者病死率高。 HIV阳性组死亡17例，阴性组死亡2例，两组病死率比较差异无统计学意义（ P＞0.05）。结论两组临床表现、实验室检查结果相似，两性霉素B抗真菌治疗效果较好，早期诊断、积极控制颅内压有助于改善预后。%Objective To analyze the clinical characteristics , treatment and prognosis of human immunode-ficiency virus antibody positive versus negative patients with cryptococcal meningitis .Methods The clinical data of 64 patients with cryptococcal meningitis who were treated in our hospital from June 2006 to June 2012 was collected . These patients were divided into 2 groups according to positive and negative for comparing and analyzing their charac-teristics.Results Both groups had the signs of fever , headache and emesis , while companying meningeal irritation and increased intracranial pressure .Compared with HIV negative group , in HIV positive group , onset was faster , fe-ver was more obvious , the time from onset to confirmation was shorter , and with more merging opportunistic infec-tions.In both groups ,cerebrospinal fluid examinations showed cell population and protein content increased , glucose and chloride content decreased .Cerebrospinal fluid cell population of HIV positive group was less than that of HIV negative group .In both groups head imagings showed meningeal change and hydrocephalus , while damaging brain pa-renchyma was found more in HIV positive group .Both groups were treated by single amphotericin B or combination of amphotericin B and other antibiotic therapy .The mortality was higher in patients who was treated without antibiotic therapy and whose intracranial pressure was higher .There were 17 patients died in HIV positive group , 2 patients died in HIV negative group .There was no statisically significant difference in mortality between two groups ( P>0.05 ) .Conclusion The clinical characteristics and laboratory test results of both groups are similar .Amphotericin B combined with other antibiotic therapy has a better therapeutic effect , early diagnosis and actively controlling in-tracranial pressure contribute to improving prognosis .