摘要
目的回顾性分析重庆地区艾滋病合并中枢神经系统（central nervous system，CNS）感染患者的疾病谱、发病率、病死率及预后影响因素。方法收集整理重庆市公共卫生医疗救治中心2013年2月至2017年2月期间收治的4 426例艾滋病患者的病例资料，从中筛选出合并CNS感染患者499例。计算CNS感染的发病率、病死率，分析不同CNS感染与CD4＋T淋巴细胞计数水平的关系及影响住院结局的相关因素。计量资料采用Mann-Whitney U检验，单因素和多因素分析采用logistic回归分析。结果本组病例中CNS感染总体发病率为11.27%（499/4 426），发病率较高的疾病分别为结核性脑膜炎199例（4.50%），新型隐球菌性脑膜炎144例（3.25%），符合CNS感染诊断标准但无病原学依据的原因不明CNS感染49例（1.11%）。CNS感染总体病死率为18.84%（94/499），其中结核性脑膜炎35例（17.59%），新型隐球菌性脑膜炎23例（15.97%），符合CNS感染诊断标准但无病原学依据的原因不明CNS感染19例（38.76%）。生存组CD4＋T淋巴细胞计数与死亡组比较差异有统计学意义（Z＝－2.51，P＝0.001）。视力下降、颈项强直、病理反射阳性、意识障碍、基线CD4＋T淋巴细胞计数〈50个/μL、基线HIV RNA≥5 lg拷贝/mL均为独立的死亡预测因子。结论重庆地区艾滋病患者CNS感染的发病率和病死率较高，多发生于严重免疫抑制患者，年龄偏大、CNS严重受损和免疫功能严重抑制是艾滋病合并CNS感染患者死亡的三个独立影响因素。
ObjectiveTo describe the disease spectrum, morbidity, mortality and prognostic factors of acquired immune deficiency syndrome （AIDS） patients complicated with central nervous system （CNS） infections.MethodsThe data of 4 426 AIDS patients from February 2013 to February 2017 in Chongqing public health medical center were collected, among which 499 cases had CNS infection. The morbidity and mortality of CNS infections were calculated. Association between different CNS infections and CD4＋ T cell counts was analyzed. Prognostic factors for the outcome of hospitalization were also studied. Mann-Whitney U test was used for continuous variables. Univariate and multivariate analyses were performed by logistic regression analysis.ResultsThe morbidity of CNS infections in AIDS patients was 11.27% （499/4 426）. The most prevalent CNS infections were tuberculous meningitis （4.50%）, cryptococcal meningitis （3.25%） and CNS infections with unknown etiology （1.11%）. The mortality rate was 18.84% （94/499）, among which tuberculous meningitis accounted for 35 cases （17.59%）, cryptococcal meningitis 23 cases （15.79%） and CNS infections with unknown etiology 19 cases （38.76%）. The average CD4＋ T cell count level in those who died were significantly lower than that in those who survived （Z=-2.51, P=0.001）. Visual impairment, nuchal rigidity, positive pathologic reflexes, consciousness disturbance, CD4＋ T cell counts〈50 cells/μL and HIV RNA≥5 lg copies/mL at baseline were independent prognostic factors for mortality.ConclusionsThe morbidity and mortality of CNS infections are high among AIDS patients in Chongqing, and those patients with severe immunosuppression are usually affected. Older age, consciousness disturtance and severe immunosuppression are three independent risk factors for mortality.
作者
鲁雁秋
黄晓婕
刘敏
吴玉珊
吴昊
卢洪洲
陈耀凯
Lu Yanqiu;Huang Xiaojie;Liu Min;Wu Yushan;Wu Hao;Lu Hongzhou;Chen Yaokai.(Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, Chin)
出处
《中华传染病杂志》
CAS
CSCD
2018年第2期65-68,共4页
Chinese Journal of Infectious Diseases
基金
“十三五”国家科技重大专项（2018ZX10302104001,2017ZX10202101004008）
北京市科技计划（D161100000416003）
关键词
获得性免疫缺陷综合征
中枢神经系统病变
疾病谱
回顾性分析
Acquired immune deficiency syndrome
Central nervous system disease
Disease spectrum
Retrospective analysis
