HIV感染者合并结核性脑膜炎临床诊治及转归的影响因素分析
发布时间：2018-10-29 20:37
【摘要】：目的了解艾滋病病毒(HIV)感染者合并结核性脑膜炎(TBM)的临床诊断和治疗,以及预后的影响因素。方法收集2011年1月1日至2013年6月30日住院治疗的24例HIV感染合并结核性脑膜炎病人,对其临床资料进行分析。结果 24例HIV感染合并结核性脑膜炎病人中,发热20例,头痛14例,意识改变12例;16例病人合并肺结核,6例合并其他HIV相关神经系统病变。CD+4T淋巴细胞(简称CD4细胞)计数中位数为76个/mm3[四分位数间距(IQR):25.3~229.3],约41.7%的病人CD4细胞计数50个/mm3。仅在2例脑脊液标本中找到抗酸杆菌。总病死率为25.0%(6/24)。低基线CD4细胞计数、意识改变、脑脊液高蛋白含量和高白细胞数以及合并其他中枢神经系统疾病,均与病死率显著相关。一线四联抗结核强化期治疗至少进行1年,能够达到良好的疗效,而由于耐受性无法选择一线四联治疗的病人病死率高。结论 HIV感染合并结核性脑膜炎病人至少进行一年的一线四联抗结核强化期治疗,能够达到良好的疗效。
[Abstract]:Objective to investigate the clinical diagnosis, treatment and prognostic factors of (HIV) infected patients with tuberculous meningitis (TBM). Methods from January 1, 2011 to June 30, 2013, 24 patients with HIV infection complicated with tuberculous meningitis were collected and their clinical data were analyzed. Results among 24 cases of HIV infection complicated with tuberculous meningitis, 20 cases had fever, 14 cases had headache and 12 cases had consciousness change. The median of CD 4 T lymphocytes (CD4 cells) was 76 / mm3 [(IQR): 25.3 + 229.3]. CD4 cell count 50 / mm3. in 41.7% of patients Acid-fast bacilli were found only in 2 cerebrospinal fluid specimens. The overall mortality was 25.0% (6 / 24). Low baseline CD4 cell count, consciousness changes, cerebrospinal fluid high protein content, high leukocyte count and other central nervous system diseases were significantly correlated with mortality. Intensive first-line quadruple anti-tuberculosis therapy for at least one year can achieve good curative effect, but the mortality of patients who can not choose first-line quadruple therapy because of tolerance is high. Conclusion the patients with HIV infection and tuberculous meningitis can get good curative effect after at least one year of intensive first-line and quadruple anti-tuberculosis therapy.
【作者单位】： 首都医科大学附属北京同仁医院感染科;首都医科大学附属北京佑安医院感染中心;
【基金】：北京市科委艾滋病重大专项(D141100000314005,D141100000314002) 国家艾滋病和病毒性肝炎等重大传染病防治科技“十二五”重大专项(2012ZX10001-003,2012ZX10001-006,2012ZX10004904-002-002) 北京市艾滋病重点实验室(BZ0089)~~
【分类号】：R512.91;R529.3
[Abstract]:Objective to investigate the clinical diagnosis, treatment and prognostic factors of (HIV) infected patients with tuberculous meningitis (TBM). Methods from January 1, 2011 to June 30, 2013, 24 patients with HIV infection complicated with tuberculous meningitis were collected and their clinical data were analyzed. Results among 24 cases of HIV infection complicated with tuberculous meningitis, 20 cases had fever, 14 cases had headache and 12 cases had consciousness change. The median of CD 4 T lymphocytes (CD4 cells) was 76 / mm3 [(IQR): 25.3 + 229.3]. CD4 cell count 50 / mm3. in 41.7% of patients Acid-fast bacilli were found only in 2 cerebrospinal fluid specimens. The overall mortality was 25.0% (6 / 24). Low baseline CD4 cell count, consciousness changes, cerebrospinal fluid high protein content, high leukocyte count and other central nervous system diseases were significantly correlated with mortality. Intensive first-line quadruple anti-tuberculosis therapy for at least one year can achieve good curative effect, but the mortality of patients who can not choose first-line quadruple therapy because of tolerance is high. Conclusion the patients with HIV infection and tuberculous meningitis can get good curative effect after at least one year of intensive first-line and quadruple anti-tuberculosis therapy.
【作者单位】： 首都医科大学附属北京同仁医院感染科;首都医科大学附属北京佑安医院感染中心;
【基金】：北京市科委艾滋病重大专项(D141100000314005,D141100000314002) 国家艾滋病和病毒性肝炎等重大传染病防治科技“十二五”重大专项(2012ZX10001-003,2012ZX10001-006,2012ZX10004904-002-002) 北京市艾滋病重点实验室(BZ0089)~~
【分类号】：R512.91;R529.3
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1 沈萍;鲁晶晶;李尽义;彭涛;贾延R，
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