【摘要】：目的了解艾滋病病毒(HIV)感染者合并結(jié)核性腦膜炎(TBM)的臨床診斷和治療,以及預(yù)后的影響因素。方法收集2011年1月1日至2013年6月30日住院治療的24例HIV感染合并結(jié)核性腦膜炎病人,對其臨床資料進(jìn)行分析。結(jié)果 24例HIV感染合并結(jié)核性腦膜炎病人中,發(fā)熱20例,頭痛14例,意識改變12例;16例病人合并肺結(jié)核,6例合并其他HIV相關(guān)神經(jīng)系統(tǒng)病變。CD+4T淋巴細(xì)胞(簡稱CD4細(xì)胞)計數(shù)中位數(shù)為76個/mm3[四分位數(shù)間距(IQR):25.3~229.3],約41.7%的病人CD4細(xì)胞計數(shù)50個/mm3。僅在2例腦脊液標(biāo)本中找到抗酸桿菌�？偛∷缆蕿�25.0%(6/24)。低基線CD4細(xì)胞計數(shù)、意識改變、腦脊液高蛋白含量和高白細(xì)胞數(shù)以及合并其他中樞神經(jīng)系統(tǒng)疾病,均與病死率顯著相關(guān)。一線四聯(lián)抗結(jié)核強化期治療至少進(jìn)行1年,能夠達(dá)到良好的療效,而由于耐受性無法選擇一線四聯(lián)治療的病人病死率高。結(jié)論 HIV感染合并結(jié)核性腦膜炎病人至少進(jìn)行一年的一線四聯(lián)抗結(jié)核強化期治療,能夠達(dá)到良好的療效。
[Abstract]:Objective to investigate the clinical diagnosis, treatment and prognostic factors of (HIV) infected patients with tuberculous meningitis (TBM). Methods from January 1, 2011 to June 30, 2013, 24 patients with HIV infection complicated with tuberculous meningitis were collected and their clinical data were analyzed. Results among 24 cases of HIV infection complicated with tuberculous meningitis, 20 cases had fever, 14 cases had headache and 12 cases had consciousness change. The median of CD 4 T lymphocytes (CD4 cells) was 76 / mm3 [(IQR): 25.3 + 229.3]. CD4 cell count 50 / mm3. in 41.7% of patients Acid-fast bacilli were found only in 2 cerebrospinal fluid specimens. The overall mortality was 25.0% (6 / 24). Low baseline CD4 cell count, consciousness changes, cerebrospinal fluid high protein content, high leukocyte count and other central nervous system diseases were significantly correlated with mortality. Intensive first-line quadruple anti-tuberculosis therapy for at least one year can achieve good curative effect, but the mortality of patients who can not choose first-line quadruple therapy because of tolerance is high. Conclusion the patients with HIV infection and tuberculous meningitis can get good curative effect after at least one year of intensive first-line and quadruple anti-tuberculosis therapy.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京同仁醫(yī)院感染科;首都醫(yī)科大學(xué)附屬北京佑安醫(yī)院感染中心;
【基金】：北京市科委艾滋病重大專項(D141100000314005,D141100000314002) 國家艾滋病和病毒性肝炎等重大傳染病防治科技“十二五”重大專項(2012ZX10001-003,2012ZX10001-006,2012ZX10004904-002-002) 北京市艾滋病重點實驗室(BZ0089)~~
【分類號】：R512.91;R529.3

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