【摘要】 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。更多还原

【Abstract】 Objective To analyze the disease spectrum,incidence and clinical characteristics of central nervous system lesions among inpatients with HIV/AIDS in China.Methods The clinical data of HIV/AIDS inpatients complicated with central nervous system lesions in Zhongnan Hospital of Wuhan University from January 2012 to April 2014 were analyzed,retrospectively.Results Central nervous system lesions were observed in 57(8.5%) cases among 672 AIDS inpatients,25(43.9%) cases had central nervous system lesions as their first clinical presentation.Their main clinical manifestations included headache(75.4%,43/57),fever(68.4%,39/57),vomiting(52.6%,30/57),positive meningeal irritation signs(40.4%,23/57),disturbance of consciousness(24.6%,14/57),muscle strength decline(24.6%,14/57) and convulsion(21.1%,12/57).The clinical examination included head CT or MRI,cerebrospinal fluid examination,blood tests,biochemical tests,immunological tests and brain biopsy.There were 34 patients with the CD4~+ T cell counts lower than 50 cells/mm~3 and 5 patients with CD4~+ T cell counts higher than 200 cells/mm~3,the remainder were between 50-200 cells/mm~3.There were 32 patients confirmed via pathogenic and histological examination and 27 patients were diagnosed relying on clinical symptoms.There were 28(49.1%) cases with cryptococcal meningitis,9(15.8%) cases with central nervous system disorders of unknown cause,5(8.8%)cases with progressive multifocal leukoencephalopathy,3(5.3%) cases with encephalomyelitis,3(5.3%) cases with tubercular meningitis,2(3.5%) cases with HIV-encephalopathy(3.5%),2 cases with toxoplasmosis,2(3.5%) cases with acute cerebral infarction of unknown cause,2(3.5%) cases with brain atrophy,1(1.7%)case with cranial tumors.Among whom,41(71.9%) patients recovered completely or improved partially and16(28.1%) patients died.The main components of mortality were patients with cryptococcal meningitis in severe late period(6 cases) and central nervous system disorders of unknown cause(5 cases).Conclusions The vast majority of patients with central nervous system disorders were in phase of AIDS period in the study,the highest incidence was cryptococcal meningitis,their disease spectrum were wide and mortality rate were high,main symptoms included headache,fever and vomiting,etc.In order to improve the diagnose rate and reduce mortality rate,it is necessary to undergo examinations to earlier diagnosis and treatment for patients with AIDS.更多还原