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目的探讨中国大陆人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)住院患者合并中枢神经系统病变的疾病谱和临床特点。方法对2012年1月至2014年4月于武汉大学中南医院住院的HIV/AIDS并发中枢神经系统病变患者的临床资料进行回顾性分析。结果 672例住院患者合并中枢神经系统病变者57例(8.5%),其中43.9%(25/57)以中枢神经系统疾病为首发疾病入院并确诊AIDS。57例患者主要中枢神经系统疾病临床表现有头痛(75.4%,43/57)、发热(68.4%,39/57)、呕吐(52.6%,30/57)、脑膜刺激征(40.4%,23/57)、意识障碍(24.6%,14/57)、肌力下降(24.6%,14/57)以及抽搐(21.1%,12/57)等;对患者进行头颅CT和(或)MRI,血液、脑脊液常规、生化、免疫学和病原学检查,部分患者行病理检查。34例(60.0%)患者外周血CD4~+T细胞计数≤50个/mm~3,18例(31.2%)患者CD4~+T细胞计数为50~200个/mm~3,5例(8.8%)患者CD4~+T细胞计数≥200个/mm~3。32例(56.1%)有病原学及病理组织学诊断依据,其余为临床诊断。诊断为隐球菌脑膜炎28例(49.1%),不明原因中枢神经系统病变9例(15.8%),脑白质病变5例(8.8%),脑脊髓炎3例(5.3%),结核性脑膜炎3例(5.3%),艾滋病相关性脑病2例(3.5%),弓形虫脑病2例(3.5%),不明原因急性脑梗塞2例(3.5%),脑萎缩2例(3.5%)以及脑肿瘤1例(1.7%)。经病原及综合诊疗好转出院41例(71.9%);死亡患者16例(21.8%),主要是接受诊疗较晚的隐球菌脑膜炎重症患者(6例)和不明原因中枢神经系统病变的患者(5例)。结论本组HIV/AIDS合并中枢神经系统病变患者绝大多数处于艾滋病期,以隐球菌脑膜炎最多见,疾病谱较广,病死率高。主要临床表现有头痛、发热、呕吐、脑膜刺激征、意识障碍、肌力下降和抽搐等。及时进行中枢神经系统疾病病原学、影像学和病理学检查,尽快明确诊断,采取相应诊疗措施,能够降低病死率。
Objective To explore the disease spectrum and clinical features of in-patients with central nervous system diseases from HIV / AIDS patients in Mainland China. Methods The clinical data of patients with HIV / AIDS complicated central nervous system diseases hospitalized in Zhongnan Hospital of Wuhan University from January 2012 to April 2014 were analyzed retrospectively. Results Among 672 hospitalized patients with central nervous system diseases, 57 (8.5%) were confirmed as pathological changes. Among them, 43.9% (25/57) were admitted to hospital with central nervous system diseases as the first disease and confirmed AIDS. The main clinical manifestations of central nervous system diseases in 57 patients were headache (75.4%, 43/57), fever (68.4%, 39/57), vomiting (52.6%, 30/57), meningeal irritation (40.4% 57), disturbance of consciousness (24.6%, 14/57), decreased strength (24.6%, 14/57) and convulsions (21.1%, 12/57) Cerebrospinal fluid routine, biochemical, immunological and pathological examination, some patients underwent pathological examination. The CD4 ~ + T cell counts in 34 patients (60.0%) with CD4 ~ + T cell count ≤50 / mm ~ 3 and in 18 (31.2%) patients were 50 ~ 200 / mm ~ %) Patients with CD4 ~ + T cell count ≥200 / mm ~ 3.322 cases (56.1%) with etiological and histopathological diagnosis based on the rest of the clinical diagnosis. 28 (49.1%) were diagnosed as cryptococcal meningitis, 9 (15.8%) with central nervous system disease of unknown cause, 5 (8.8%) with leukoaraiosis, 3 (5.3%) with encephalomyelitis, 3 cases (5.3%), 2 cases of AIDS related encephalopathy (3.5%), 2 cases of toxoplasmosis (3.5%), 2 cases of unexplained acute cerebral infarction (3.5%), 2 cases of brain atrophy Tumor in 1 case (1.7%). 41 cases (71.9%) were discharged after the pathogen and the comprehensive diagnosis and treatment were improved; 16 patients died (21.8%), mainly patients with cryptococcal meningitis (6 cases) and patients with unexplained central nervous system diseases 5 cases). Conclusion The majority of HIV / AIDS patients with central nervous system diseases in this group are in AIDS stage. Cryptococcal meningitis is the most common disease with a wide spectrum of diseases and high case fatality rate. The main clinical manifestations are headache, fever, vomiting, meningeal irritation, disturbance of consciousness, decreased muscle strength and convulsions. Timely central nervous system disease etiology, imaging and pathology, as soon as possible to confirm the diagnosis, take the appropriate diagnosis and treatment measures, can reduce the case fatality rate.