摘要
目的分析艾滋病合并隐球菌性脑膜炎(AIDS/CM)与艾滋病合并结核性脑膜炎(AIDS/TBM)临床特征,为临床鉴别诊断提供依据。方法收集AIDS/CM与AIDS/TBM患者临床资料,比较其人口学信息、临床表现、实验室检查、影像学检查及转归的异同。结果共纳入AIDS/CM 122例,AIDS/TBM 52例;两组病例在人口学方面差异无统计学意义;临床表现比较:AIDS/TBM患者发热和意识障碍发生率显著高于AIDS/CM患者(P<0.05);实验室检查结果比较:AIDS/CM患者CD4^+T淋巴细胞计数水平较AIDS/TBM患者低;AIDS/TBM患者脑脊液蛋白水平显著高于AIDS/CM患者,而脑脊液压力及脑脊液氯化物定量水平显著低于AIDS/CM患者(P <0.05);影像学比较:AIDS/CM患者肺部病灶发生率显著低于AIDS/TBM患者,但基底节病变发生率显著高于AIDS/TBM患者(P<0.05)。结论 AIDS/CM与AIDS/TBM在临床表现、实验室检查结果及影像学表现上存在差异,经综合分析容易找到鉴别诊断线索。
Objective Tuberculous mentingitis(TBM) and cryptococcal meningitis(CM) share many common clinical features in AIDS patients, which is a challenge to differential diagnosis. This study aimed to examine the difference of clinical features between CM and TBM in AIDS patients for better differential diagnosis in clinical practice. Methods Clinical data of CM and TBM cases in AIDS patients were collected to compare the demographic characteristics, clinical manifestations, laboratory testing results, imaging findings, and clinical outcomes. Results This study included 122 CM cases and 52 TBM cases in AIDS patients. No statistical difference was found in demographics between the two groups. TBM patients showed significantly higher incidence of fever and disturbance of consciousness than CM patients(P<0.05). CM patients had lower CD4^+T lymphocyte count than TBM patients. But TBM patients showed significantly higher level of cerebrospinal fluid protein, significantly lower cerebrospinal fluid pressure and cerebrospinal fluid chloride than CM patients(P<0.05). Imaging study revealed significantly lower incidence of lung lesions and significantly higher incidence of basal ganglia lesions in CM patients than in TBM patients(P<0.05). Conclusions The difference in clinical presentation, CSF testing results and imaging findings between CM and TBM in AIDS patients provides a key to differential diagnosis in clinical practice.
作者
吴玉珊
刘敏
鲁雁秋
袁婧
邓长刚
何坤
曾琴
陈耀凯
WU Yushan;LIU Min;LU Yanqiu;YUAN Jing;DENG Changgang;HE Kun;ZENG Qin;CHEN Yaokai(Department of Infectious Diseases,Chongqing Public Health Medical Center,Chongqing 400036,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2019年第6期590-593,共4页
Chinese Journal of Infection and Chemotherapy
基金
“十三五”国家科技重大专项（2018ZX10302104-001,2017ZX10202101-004-008）
重庆市科卫联合项目（2011-2-390）
重庆市公共卫生医疗救治中心青年科研创新基金（19QNKYXM09）
