摘要
目的探索人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者合并巨细胞病毒(CMV)中枢神经系统感染的情况。方法对2012年1月-2018年5月广州医科大学附属市八医院收治的48例HIV/AIDS合并CMV中枢神经系统感染患者的临床资料进行回顾性分析。结果48例HIV/AIDS合并CMV中枢神经系统感染患者,其中男35例(72.92%),女13例(27.08%),平均年龄(39.81±10.54)岁;接受抗病毒治疗(ART)共32例(66.67%)。在ART过程中,有2例患者出现免疫重建炎性反应综合征(IRIS)。脑脊液平均压力(146.76±102.52)cmH2O(剔除2例合并化脓性脑膜炎及6例合并结核性脑膜炎患者),脑脊液HIV RNA检测仅23例,其中HIV RNA阳性19例(82.60%),平均值(3.41±1.16)lg copies/mL。48例患者CD4细胞计数为12.5个/μL(IQR:6.0~47.5个/μL),<50个/μL;血清CMV DNA阳性仅35例(72.92%),阴性13例(27.08%),血清CMV DNA平均值(3.68±0.81)lg copies/mL,低于脑脊液CMV DNA平均值(4.42±1.39)lg copies/mL。随访至出院后6个月,好转25例(52.08%),死亡18例(37.35%),失访5例(10.42%)。结论HIV/AIDS合并CMV中枢神经系统感染患者多发生于CD4细胞计数<50个/μL的患者,其临床症状体征多样,脑脊液检查无明显特异性,往往并有CMV血症,即使血CMV DNA阴性也不能排除。临床并发症多,治疗效果不理想,死亡率高,预后不佳。
Objective To explore the clinical manifestation,diagnosis,treatment and prognosis of central nervous system infection caused by cytomegalovirus (CMV)in patients with human immunodeficiency virus(HIV)/acquired immunodeficiency syndrome(AIDS).Method The clinical data of 48 HIV/AIDS patients with CMV encephalitis admitted to the Guangzhou Eighth People's Hospital,Guangzhou Medical University from January 2012 to May 2018 were analyzed retrospectively.Results There were 48 HIV/AIDS patients with CMV central nervous system infection,including 35 males(72.92%)and 13 females(27.08%),with an average age of(39.81±10.54)years old.Among them,32 cases(66.67%)received antiretroviral therapy(ART).In the course of ART,2 patients developed immune reconstruction inflammatory syndrome(IRIS).The mean pressure of cerebrospinal fluid in patients was(146.76±102.52)cmH2O(excluding 2 patients with purulent meningitis and 6 patients with tuberculous meningitis),and only 23 patients were tested for HIV RNA;among which,19 cases were HIV RNA positive(82.60%),with the mean value of(3.41±1.16)lg copies/mL.The CD4 cell counts of 48 patients were 12.5 cells/μL(IQR:6.0~47.5 cells/μL),<50 cells/μL.Out of 48 patients,only 35 cases(72.92%)were positive for CMV DNA in serum,while 13 cases(27.08%)were negative,and the an average value of CMV DNA in serum was(3.68±0.81)lg copies/mL,which was lower than the average level of CMV DNA in cerebrospinal fluid[(4.42±1.39)lg copies/mL].Followed up to 6 months after discharge,25 cases(52.08%)improved,18 cases(37.35%)died,and 5 cases(10.42%)were lost to follow-up.Conclusions HIV/AIDS patients with CMV central nervous system infection mostly occurred in patients with CD4 cell counts<50/μL,and their clinical symptoms and signs were diverse and cerebrospinal fluid examination had no obvious specificity,and they often had CMV anemia,which could not be ruled out even if the blood CMV DNA was negative.There were many clinical complications,unsatisfactory treatment effect,high mortality and poor prognosis.
作者
孟玉
陈谐捷
李凌华
蔡卫平
关家龙
李粤平
MENG Yu;CHEN Xiejie;LI Linghua;CAI Weiping;GUAN Jialong;LI Yueping(Infectious Disease Center,Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou,Guangdong 510060,China)
出处
《热带医学杂志》
CAS
2023年第6期785-788,共4页
Journal of Tropical Medicine
基金
“十三五”国家科技重大专项(2018ZX10302104-001-007)
广州市科技计划项目(202206010009)
