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目的了解上海市公共卫生临床中心近5年艾滋病合并中枢神经系统病变的发病情况及各类疾病特点。方法对2010年1月至2015年1月,该中心收治的艾滋病合并中枢神经系统病变病人资料进行回顾性分析。结果期间共收治艾滋病合并中枢神经系统病变病人339例,隐球菌脑膜炎占36.0%(122例),结核性脑膜炎占10.9%(37例),神经梅毒占10.6%(36例),诊断未明占10.0%(34例),弓形虫脑病占10.0%(34例),脑血管疾病占5.0%(17例),进行性多灶性白质脑病占4.4%(15例),混合感染占3.8%(13例),化脓性脑膜炎占3.5%(12例),HIV相关性脑病占2.7%(9例),病毒性脑膜炎占1.2%(4例),非结核分枝杆菌感染占1.2%(4例),颅内肿瘤占0.6%(2例)。除神经梅毒外,各类中枢神经系统病变病人的CD4+T淋巴细胞中位数水平均低于200个/μL,其中隐球菌脑膜炎最低,为21个/μL。诊断未明病人在院病死率最高,为29.4%;其次为结核性脑膜炎16.2%。结论艾滋病合并中枢神经系统病变以隐球菌脑膜炎多见,各类疾病的临床表现多样,CD4+T淋巴细胞中位数低,病死率高。
Objective To understand the incidence of AIDS-related central nervous system diseases in recent five years in Shanghai Public Health Clinical Center and the characteristics of various diseases. Methods From January 2010 to January 2015, the data of patients with central nervous system diseases complicated with AIDS who were admitted to the center were retrospectively analyzed. During the study, 339 cases of AIDS complicated with central nervous system diseases were treated, including 36.0% (122 cases) of cryptococcal meningitis, 10.9% (37 cases) of tuberculous meningitis and 10.6% (36 cases) of neurosyphilis. The diagnosis was unknown Accounting for 10.0% (34 cases), toxoplasmosis (10.0%), cerebrovascular disease (17 cases), progressive multifocal leukoencephalopathy (4.4%), mixed infection accounting for 3.8% (13 cases), purulent meningitis accounted for 3.5% (12 cases), HIV-related encephalopathy accounted for 2.7% (9 cases), viral meningitis accounted for 1.2% (4 cases), non-tuberculous mycobacterium infection accounted for 1.2% (4 cases), intracranial tumors accounted for 0.6% (2 cases). In addition to neurosyphilis, the median CD4 + T lymphocyte levels in all CNS patients were below 200 / μL, with the lowest cryptococcal meningitis at 21 / μL. The highest case-fatality rate was 29.4% in the unknown patients, followed by tuberculosis meningitis 16.2%. Conclusion The AIDS-associated central nervous system lesions are more common in cryptococcal meningitis. The clinical manifestations of various diseases are diverse. The median CD4 + T lymphocyte count is low and the case fatality rate is high.