AIDS及非AIDS相关新型隐球菌性脑膜脑炎的临床及影像学对照研究

摘要

Objective: To study clinical and imaging features of cryptococcal meningoencephalitis in patients with AIDS and without AIDS. Methods:We retro spectively analyzed the common and different points between AIDS (n = 23) and non AIDS (n = 16) related cryptococcal meningoencephalitis in clinical features, duration of hospitalization, treatment, prognosis and images. Results:The AIDS group and non AIDS group had the same age range. The duration of hospitalization of the former group was longer than that of the latter one. Clinical features of AIDS group manifested as same as non AIDS group as headache,fever,nausea and vomit. However,the secondary symptoms of AIDS group as meningeal irritation sign, visual impairment and cryptococcal pneumonia were more serious than non AIDS group(13. O/o vs 6. 3/o ,13. O/o vs 6. 3/o , 43. 5% vs 0). From which,there was statistical difference of symptoms of c. p. between the two groups. P＜0. 05. The ca ses with CD4 cell count less than l00ul in AIDS group (23 cases) were much more than non AIDS group (12. 5 % ,2 cases), P＜0. 05. Also AIDS group had a higher mortality than non AIDS group (17. 4% vs 6. 3%). The main image features in eluded Virchow Robin space dilatation, meningeal enhancement, gelatinous pseudocysts and hydrocephalus. Of which the meningeal enhancement and granulomous lesions were less than those in non AIDS group(3 vs 9 ,1 vs 5 ,0 vs 4). Conclusion: Cryptococcal meningo encephatilis in Aids patients has more serious clinical secondary symptoms, less therapeutic effects and nigner mortality. 1 ne meningeal enhancement and granulomous lesions of AIDS group are less encountered tnan tnose inrnnon AIDS group.%目的:对比分析艾滋病(AIDS)与非AIDS相关新型隐球菌性脑膜脑炎(CM)的临床及影像学表现,进一步指导临床治疗.方法:回顾性分析23例AIDS相关CM患者(AIDS组)与16例非AIDS相关CM患者(非AIDS组)的临床症状、体征及影像学表现的异同.结果:AIDS组与非AIDS组发病年龄相仿,前者住院时间长于后者,主要临床表现相似,均为头痛、发热、恶心呕吐,AIDS组继发脑膜刺激征、视力损伤及隐球菌肺炎的概率(分别为13.0%、13.0%、43.5%)较非AIDS组高(分别为6.3%、6.3%、0),其中继发隐球菌肺炎在AIDS组与非AIDS组中差异有统计学意义(P%0.05).AIDS组CD4+T细胞计数<100个/μl的患者(23例,100%)多于非AIDS组(2例,12.5%),两组差异有统计学意义(P<0.05).AIDS组病死率(17.4%)高于非AIDS组(6.3%).影像学主要表现为VR间隙扩大、胶样假囊形成、脑膜强化、脑积水及肉芽肿性病变,其中AIDS组脑膜强化、肉芽肿性病变(分别为3例、1例)均少于非AIDS组(分别为9例、5例),且二者在两组间差异均有统计学意义(P<0.05).结论:AIDS相关CM患者免疫力低下,临床继发症状重,治疗效果差,病死率高.AIDS组脑膜强化及肉芽肿性病变明显低于非AIDS组.