摘要
目的探索艾滋病(AIDS)合并隐球菌脑膜炎治疗失败的风险因素。方法采用回顾性分析的方法,记录2008年1月至2013年6月,在广州医科大学附属第八人民医院住院治疗的AIDS合并隐球菌性脑膜炎100例患者,入院时的临床症状、实验室检查结果。按90天预后分为治疗成功(治愈和改善)和治疗失败(死亡、无效和复发)两组。结果 100例AIDS合并隐球菌性脑膜炎患者中,男性75例,女性25例。治疗成功组56例(治愈21例,好转35例),治疗失败组44例(死亡35例,复发9例),两组年龄、性别差异无统计学意义(P=0.212;P=0.642)。治疗失败组患者出现神志改变明显多于治疗成功组患者(P=0.008),治疗成功组CD+4T淋巴细胞计数高于治疗失败组(P=0.025),治疗失败组入院初次腰椎穿刺脑脊液压力明显高于治疗成功组(P=0.014)。在治疗成功组有更多的患者选择含有两性霉素B的治疗方案和使用激素治疗。Logistic回归分析显示,有神志改变、脑脊液抗原阳性、未使用激素是90天治疗失败的预测因子。结论 AIDS合并隐球菌脑膜炎临床预后受多种因素影响,对于CD+4T淋巴细胞计数严重低下、有神志改变、脑脊液抗原阳性的患者应加强管理。
Objective The study was to investigate risk factors influencing treatment failure of acquired immunodeficiency syndrome （AIDS） complicated with cryptococcal meningitis （CM）. Methods Clinical and laboratory data of 100 AIDS patients complicated with CM were collected from January 2008 to June 2013. Based on treatment outcome on day 90, these subjects were divided into treatment success group （cure and improvement） and treatment failure group （death, no effects and relapse）. Results Of the 100 patients, 75 were male and 25 were female. Treatment success group included 56 patients （21 cases of cure and 35 cases of improvement）, while treatment failure group included 44 patients （35 cases of death and 9 cases of relapse）. There were no significant differences in gender and age between two groups （P〈 0.212;P〈 0. 642）. Altered mental status was more common in the treatment failure group than that in treatment success group （P〈0. 008）. Mean CD4 count was higher in treatment success group than that in treatment failure group （P=0. 025）. CSF Opening pressure was higher in treatment failure group than in treatment success group （P= 0. 014）. More patients took medication containing amphotericin B and Glucocorticoid in treatmen success group than in treatment failure group. Altered mental status, positive CSF cryptococcal antigen and no glucocorticoid for treatment were predictors of treatment failure at day 90. Conclusion Clinical outcome of cryptococcal meningitis in HlV-infected patients was influenced by many factors. Patients with low CD4 cell count, altered mental status or positive CSF cryptococcal antigen should be paid more attention.
出处
《中国艾滋病性病》
CAS
2014年第5期319-321,330,共4页
Chinese Journal of Aids & STD
基金
国家"十二.五"科技重大专项(2012ZX10001003-003)~~
