艾滋病合并结核性脑膜炎和新型隐球菌性脑膜炎的临床特征比较
Comparison of clinical features of tuberculous meningitis and cryptococcus neoformans meningitis in patients with acquired immunodeficiency syndrome
柯迎春 1陈景良 1蔡卫平 1郭朋乐 1潘能浪 1陈谐捷 1李凌华1
作者信息
- 1. 广州医科大学附属市八医院感染病中心,广州 510440
- 折叠
摘要
目的 探索艾滋病(AIDS)合并结核性脑膜炎(TBM)和新型隐球菌性脑膜炎(CNM)的临床特征,为临床早期鉴别诊断提供依据.方法 纳入2011年1月至2022年2月在广州医科大学附属市八医院住院且出院分别诊断为合并TBM和CNM的AIDS患者,回顾性分析21例AIDS合并TBM(TBM组)和54例AIDS合并CNM患者(CNM组)(均为病原学诊断)的临床特征,包括脑膜炎相关症状和体征,入院时血常规、CD4+T淋巴细胞计数、影像学检查、脑脊液检查等.统计学分析采用独立样本t检验、秩和检验或x2检验.结果 TBM组患者的年龄为(44.6±12.9)岁,大于CNM组患者[(37.6± 12.6)岁],差异有统计学意义(t=-2.15,P=0.035).CNM组分别有48例(88.89％)和7例(12.96％)出现头痛和意识障碍,与TBM组[13例(61.90％)和9例(42.86％)]的差异均有统计学意义(x2=7.25,P=0.007;x2=8.05,P=0.005).CNM组白细胞计数减少的患者比例为27.78％(15/54),血小板计数减少的患者比例为16.67％(9/54),分别高于TBM组[4.76％(1/21)和0(0/21)],差异均有统计学意义(x2=4.77,P=0.029;x2=3.98,P=0.042).TBM 组 CD4+T 淋巴细胞计数为 74.0(92.0)/μL,高于CNM组的19.5(56.5)/μL,差异有统计学意义(Z=-2.87,P=0.009).CNM组分别有46例(85.19％)和 24 例(44.44％)患者脑脊液压力＞180 mmH2O(1 mmH2O=0.009 8 kPa)和＞330 mmH2O,高于 TBM 组[7 例(33.33％)和 4 例(19.05％)],差异均有统计学意义(x2=19.61,P＜0.001;x2=4.17,P=0.041).TBM组脑脊液白细胞数＞200 × 106/L的患者比例为52.38％(11/21),高于CNM组[1.85％(1/54)],差异有统计学意义(x2=27.23,P＜0.001).TBM组脑脊液白细胞数、蛋白质、腺苷脱氨酶高于 CNM 组[200.00(579.50)×106/L 比 17.50(66.25)×106/L,1 863(2 858)mg/L 比 672(513)mg/L,6.60(8.55)U/L 比 1.95(2.60)U/L],脑脊液氯化物低于 CNM 组[(107.71±8.22)mmol/L 比(115.99± 6.55)mmol/L],差异均有统计学意义(Z=4.11,P＜0.001;Z=21.23,P=0.008;Z=2.09,P=0.040;t=4.57,P＜0.001).TBM组和CNM组脑脊液葡萄糖差异无统计学意义[(1.86±1.22)mmol/L比(2.34± 1.05)mmol/L,t=-1.72,P=0.090].TBM组双肺出现病变的比例高于CNM组,差异有统计学意义[100.00％(21/21)比 40.74％(22/54),x2=-6.53,P=0.011].结论 AIDS 合并 TBM 患者意识障碍更为多见,脑脊液炎症反应更为明显,双肺病变更多见;而AIDS合并CNM患者则头痛、脑脊液压力升高明显,白细胞和血小板计数减少更多见,且外周血CD4+T淋巴细胞计数低.
Abstract
Objective To explore the early differential diagnosis method by comparing the clinical characteristics of acquired immunodeficiency syndrome(AIDS)patients complicated with tuberculous meningitis(TBM)and cryptococcus neoformans meningitis(CNM).Methods The AIDS patients admitted to Guangzhou Eighth People's Hospital,Guangzhou Medical University from January 2011 to February 2022 and diagnosed with combined TBM and CNM after discharge respectively were included.A retrospective study was performed to analyze the clinical features of 21 AIDS patients complicated with TBM(TBM group)and 54 AIDS patients with CNM(CNM group)(all cases were confirmed by etiology).The data of meningitis-related symptoms and signs,blood routine test,CD4+T lymphocyte counts,imaging characteristics and cerebrospinal fluid examination at admission were collected and analyzed.Statistical analysis was performed by using independent sample t test,rank sum test or chi-square test.Results The age of patients in the TBM group was(44.6±12.9)years old,which was older than that of patients in the CNM((37.6±12.6)years old),the difference was statistically significant(t=-2.15,P=0.035).Forty-eight cases(88.89％)and seven cases(12.96％)in the CNM group experienced headaches and consciousness disorders respectively,with statistically significant differences compared to those in the TBM group(13 cases(61.90％)and nine cases(42.86％),respectively)(X2=7.25,P=0.007 andx2=8.05,P=0.005,respectively).The proportion of leukopenia was 27.78％(15/54),and proportion of thrombocytopenia was 16.67％(9/54)in the CNM group,which were higher than those in the TBM group(4.76％(1/21)and 0(0/21),respectively),and the differences were statistically significant(x2=4.77,P=0.029 and x2=3.98,P=0.042,respectively).The CD4+T lymphocyte count in the TBM group was 74.0(92.0)/μL,which was higher than 19.5(56.5)/µL in the CNM group,and the difference was statistically significant(Z=-2.87,P=0.009).The CNM group had 46 cases(85.19％)with cerebrospinal fluid pressure＞180 mmH2O(1 mmH2O=0.009 8 kPa)and 24 cases(44.44％)with cerebrospinal fluid pressure＞330 mmH2O,which were significantly higher than those in the TBM group with seven cases(33.33％)and four cases(19.05％),respectively,and the differences were statistically significant(x2=19.61,P＜0.001 and x2=4.17,P=0.041,respectively).Fifty-two point three eight percent(11/21)of patients in the TBM group had a white blood cell counts＞200 × 106/L in the cerebrospinal fluid,which was higher than that in the CNM group(1.85％(1/54)),with a statistically significant difference(x2=27.23,P＜0.001).The white blood cell counts,protein and adenosine deaminase levels in the cerebrospinal fluid of TBM group were significantly higher than those in the CNM group(200.00(579.50)× 106/L vs 17.50(66.25)× 106/L,1 863(2 858)mg/L vs 672(513)mg/Land 6.60(8.55)U/L vs 1.95(2.60)U/L,respectively),and the cerebrospinal fluid chloride level was lower than that in the CNM group((107.71±8.22)mmol/L vs(115.99±6.55)mmol/L),and all the differences were statistically significant(Z=4.11,P＜0.001,Z=21.23,P=0.008,Z=2.09,P=0.040 and t=4.57,P＜0.001,respectively).There was no significant difference in cerebrospinal fluid glucose between the TBM group and the CNM group((1.86±1.22)mmol/L vs(2.34±1.05)mmol/L,t=-1.72,P=0.090).The proportion of patients with bilateral lung lesions in the TBM group was higher than that in the CNM group,and the difference was statistically significant(100.00％(21/21)vs 40.74％(22/54),x2=-6.53,P=0.011).Conclusions Patients with AIDS complicated with TBM are more likely to have consciousness disorders,inflammatory response in the cerebrospinal fluid,and more bilateral lung lesions.In contrast,patients with AIDS complicated with CNM are more frequently to experience severe headache and significant elevation of cerebrospinal fluid pressure,leukopenia and thrombocytopenia,and lower peripheral blood CD4+T lymphocyte counts.
关键词
获得性免疫缺陷综合征/结核,脑膜/新型隐球菌性脑膜炎/临床特征Key words
Acquired immunodeficiency syndrome/Tuberculosis,meningeal/Cryptococcus neoformans meningitis/Clinical features引用本文复制引用
基金项目
广东省中医药局科研项目(20232140)
广州市科技计划(2023A03J0794)
出版年
2024
NETL
NSTL
万方数据