艾滋病合并新型隐球菌脑膜炎患者实验室检查分析
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摘要
目的 为艾滋病(Acquired Immunodeficiency Syndrome,AIDS)患者临床早期发现诊断新型隐球菌脑膜炎(Cryptococcal Meningitis,CM)提供依据,探讨AIDS合并CM患者与AIDS非神经系统感染/病变患者之间实验室检查指标的差异,及其临床意义。方法 回顾性分析医院2013-2018年收治的AIDS患者的临床资料,将AIDS合并CM患者45例作为研究组,以同期收治的AIDS非神经系统感染/病变患者40例作为对照组,分析两组患者各项实验室指标。结果 组间对照分析结果显示住院天数、脑脊液压力、脑脊液总细胞、脑脊液白细胞、脑脊液总蛋白、脑脊液葡萄糖(GLU)、脑脊液氯化物、红细胞、血红蛋白、血沉、降钙素原、血氯、谷草转氨酶、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)等15项指标差异有统计学意义(P<0.05);差异指标纳入Logistic回归分析,结果显示脑脊液压力、脑脊液GLU、血LDH等3项指标差异有统计学意义(P<0.05),OR值分别为1.027、0.093、0.991。结论 AIDS合并CM患者脑脊液压力高于AIDS非神经系统感染/病变患者,而脑脊液GLU、血LDH低于AIDS非神经系统感染/病变患者。CM相对其他AIDS指征性疾病,炎性渗出和组织器官损伤较轻,血LDH、α-HBDH较低。
OBJECTIVE To provide more clues for the early clinical detection and diagnosis of Cryptococcus neoformans meningitis(CM) in AIDS patients, this study explored the possible clinical significance of differences of laboratory indicators in patients with AIDS complicated with CM and patients with AIDS non-neurological infection/lesion. METHODS Retrospective analysis was performed on the clinical data of AIDS patients admitted to Beijing Ditan hospital Affiliated to Capital Medical University from 2013 to 2018. 45 patients with AIDS complicated with CM were selected as the study group, and 40 patients with AIDS non-neurological infection/lesion admitted during the same period were selected as the control group. Statistical analysis was performed on various laboratory indicators. RESULTS The results of intergroup control analysis showed significant differences in 15 indicators including the number of days in hospital, cerebrospinal fluid(CSF) pressure, CSF total cells, CSF white blood cells, proteins of CSF, CSF glucose(GLU), CSF chloride, red blood cells, hemoglobin, erythrocyte sedimentation rate, procalcitonin, blood chlorine, aspertate aminotransferase, lactate dehydrogenase(LDH) and alpha hydroxy butyric acid dehydrogenase(α-HBDH)(P<0.05). The indexes with difference were included in Logistic regression analysis, and the results showed that the differences in three indexes including CSF pressure, CSF glucose and blood LDH were significant(P<0.05), and the OR values were 1.027, 0.093 and 0.991, respectively. CONCLUSION The CSF pressure of patients with AIDS complicated with CM was higher than that of patients with AIDS non-neurological infection/lesion, while the CSF glucose and blood LDH were lower than those of patients with AIDS non-neurological infection/lesion. Considering that CM had less inflammatory exudation and tissue and organ damage than other AIDS indicative diseases, it may lead to the relatively low LDH and α-HBDH in the blood of.
OBJECTIVE To provide more clues for the early clinical detection and diagnosis of Cryptococcus neoformans meningitis(CM) in AIDS patients, this study explored the possible clinical significance of differences of laboratory indicators in patients with AIDS complicated with CM and patients with AIDS non-neurological infection/lesion. METHODS Retrospective analysis was performed on the clinical data of AIDS patients admitted to Beijing Ditan hospital Affiliated to Capital Medical University from 2013 to 2018. 45 patients with AIDS complicated with CM were selected as the study group, and 40 patients with AIDS non-neurological infection/lesion admitted during the same period were selected as the control group. Statistical analysis was performed on various laboratory indicators. RESULTS The results of intergroup control analysis showed significant differences in 15 indicators including the number of days in hospital, cerebrospinal fluid(CSF) pressure, CSF total cells, CSF white blood cells, proteins of CSF, CSF glucose(GLU), CSF chloride, red blood cells, hemoglobin, erythrocyte sedimentation rate, procalcitonin, blood chlorine, aspertate aminotransferase, lactate dehydrogenase(LDH) and alpha hydroxy butyric acid dehydrogenase(α-HBDH)(P<0.05). The indexes with difference were included in Logistic regression analysis, and the results showed that the differences in three indexes including CSF pressure, CSF glucose and blood LDH were significant(P<0.05), and the OR values were 1.027, 0.093 and 0.991, respectively. CONCLUSION The CSF pressure of patients with AIDS complicated with CM was higher than that of patients with AIDS non-neurological infection/lesion, while the CSF glucose and blood LDH were lower than those of patients with AIDS non-neurological infection/lesion. Considering that CM had less inflammatory exudation and tissue and organ damage than other AIDS indicative diseases, it may lead to the relatively low LDH and α-HBDH in the blood of.
引文
[1] 中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南(第三版)[J].中华传染病杂志,2015,33(10):577-593.
[2] Molloy SF,Chiller T,Greene GS,et al.Cryptococcal meningitis:a neglected NTD [J].PLoS Negl Trop Dis,2017,11(6):e0005575.
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[4] 李鹏程.隐球菌性脑膜炎治疗延误分析及基于人工神经网络的诊断模型[D].浙江:浙江大学,2018:40-46.
[5] Nishikawa MM,Almeida-Paes R,Brito-Santos F,et al.Comparative antifungal susceptibility analyses of Cryptococcus neoformans VNI and Cryptococcus gattii VGII from the Brazilian Amazon Region by the Etest,Vitek 2,and the Clinical and Laboratory Standards Institute broth microdilution methods[J].Med Mycol,2019,17.doi:10.1093/mmy/myy150.
[6] 中华医学会感染病学分会.隐球菌性脑膜炎诊治专家共识[J].中华内科杂志,2018,57(5):317-323.
[7] Rajasingham R,Meya DB,Greene GS,et al.Evaluation of a national cryptococcal antigen screening program for HIV-infected patients in Uganda:a cost-effectiveness modeling analysis[J].PLoS One,2019,14(1):e0210105.
[8] Chen J,Zhang R,Shen Y,et al.Serum cryptococcal antigen titre as a diagnostic tool and a predictor of mortality in HIV-infected patients with cryptococcal meningitis[J].HIV Med,2019,20(1):69-73.
[9] 魏丹丹,黄先琪,李小菊,等.隐球菌抗原-胶体金免疫层析法在隐球菌性脑膜炎和隐球菌性肺炎诊断中的应用价值[J].中华医院感染学杂志,2018,28(9):1281-1283.
[10] Oyella J,Meya D,Bajunirwe F,et al.Prevalence and factors associated with cryptococcal antigenemia among severely immunosuppressed HIV-infected adults in Uganda:a cross-sectional study[J].J Int AIDS Soc,2012,15(1):15.
[11] 戴璐,丁烨,俞娟.新生隐球菌研究进展[J].中华医院感染学杂志,2018,28(17):2708-2711.
[12] Crabtree Ramirez B,Caro Vega Y,Shepherd BE,et al.Outcomes of HIV-positive patients with cryptococcal meningitis in the Americas[J].Int J Infect Dis,2017,63:57-63.
[13] Ogundeji AO,Albertyn J,Pohl CH,et al.Method for identification of Cryptococcus neoformans and Cryptococcus gattii useful in resource-limited settings[J].J Clin Pathol,2016,69(4):352-357.
[14] Bicanic T,Brouwer AE,Meintjes G,et al.Relationship of cerebrospinal fluid pressure,fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures[J].AIDS,2009,23(6):701-706.
[15] 鲁雁秋,黄晓婕,吴玉珊,等.203例艾滋病合并新型隐球菌性脑膜炎患者预后影响因素研究[J].中华神经医学杂志,2018,17(4):397-401.
[16] 鲁雁秋,邱丹,陈耀凯.艾滋病合并新型隐球菌性脑膜炎患者的综合治疗[J].中华临床感染病杂志,2018,11(2):156-160.
[17] Chastain DB,Henao-Martinez AF,Franco-Paredes C.Opportunistic invasive mycoses in AIDS:cryptococcosis,histoplasmosis,coccidiodomycosis,and talaromycosis[J].Curr Infect Dis Rep,2017,19(10):36.
[18] Eshun-Wilson I,Okwen MP,Richardson M,et al.Early versus delayed antiretroviral treatment in HIV-positive people with cryptococcal meningitis[J].Cochrane Database Syst Rev,2018,7:CD009012.
[19] Boulware DR,Meya DB,Muzoora C,et al.Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis[J].N Engl J Med.2014,370(26) 2487-2498.
[20] 孙继云,唐会云,徐新民,等.艾滋病合并隐球菌性脑膜炎70例临床分析[J].国际检验医学杂志,2017,38(19):2781-2782.
[21] 沈银忠,齐唐凯,张仁芳,等.艾滋病合并隐球菌脑膜炎的临床特点及预后[J].中华传染病杂志,2009,27(1):48-50.
[22] Liu ZY,Wang GQ,Zhu LP,et al.Expert consensus on the diagnosis and treatment of cryptococcal meningitis[J].Zhonghua Nei Ke Za Zhi,2018,57(5):317-323.
[23] Xu L,Zhang X,Guo Y,et al.Unique clinical features of cryptococcal meningitis among Chinese patients without predisposing diseases against patients with predisposing diseases[J].Med Mycol,2019,16.doi:10.1093/mmy/myy154.
[24] Xiao J,Gao G,Li Y,Zhang W,et al.Spectrums of opportunistic infections and malignancies in HIV-infected patients in tertiary care hospital,China[J].PLoS One,2013,8(10):e75915.
[2] Molloy SF,Chiller T,Greene GS,et al.Cryptococcal meningitis:a neglected NTD [J].PLoS Negl Trop Dis,2017,11(6):e0005575.
[3] McKenney J,Bauman S,Neary B,et al.Prevalence,corre-lates,and outcomes of cryptococcal antigen positivity among patients with AIDS,United States,1986-2012[J].Clin Infect Dis,2015,60(6):959-965.
[4] 李鹏程.隐球菌性脑膜炎治疗延误分析及基于人工神经网络的诊断模型[D].浙江:浙江大学,2018:40-46.
[5] Nishikawa MM,Almeida-Paes R,Brito-Santos F,et al.Comparative antifungal susceptibility analyses of Cryptococcus neoformans VNI and Cryptococcus gattii VGII from the Brazilian Amazon Region by the Etest,Vitek 2,and the Clinical and Laboratory Standards Institute broth microdilution methods[J].Med Mycol,2019,17.doi:10.1093/mmy/myy150.
[6] 中华医学会感染病学分会.隐球菌性脑膜炎诊治专家共识[J].中华内科杂志,2018,57(5):317-323.
[7] Rajasingham R,Meya DB,Greene GS,et al.Evaluation of a national cryptococcal antigen screening program for HIV-infected patients in Uganda:a cost-effectiveness modeling analysis[J].PLoS One,2019,14(1):e0210105.
[8] Chen J,Zhang R,Shen Y,et al.Serum cryptococcal antigen titre as a diagnostic tool and a predictor of mortality in HIV-infected patients with cryptococcal meningitis[J].HIV Med,2019,20(1):69-73.
[9] 魏丹丹,黄先琪,李小菊,等.隐球菌抗原-胶体金免疫层析法在隐球菌性脑膜炎和隐球菌性肺炎诊断中的应用价值[J].中华医院感染学杂志,2018,28(9):1281-1283.
[10] Oyella J,Meya D,Bajunirwe F,et al.Prevalence and factors associated with cryptococcal antigenemia among severely immunosuppressed HIV-infected adults in Uganda:a cross-sectional study[J].J Int AIDS Soc,2012,15(1):15.
[11] 戴璐,丁烨,俞娟.新生隐球菌研究进展[J].中华医院感染学杂志,2018,28(17):2708-2711.
[12] Crabtree Ramirez B,Caro Vega Y,Shepherd BE,et al.Outcomes of HIV-positive patients with cryptococcal meningitis in the Americas[J].Int J Infect Dis,2017,63:57-63.
[13] Ogundeji AO,Albertyn J,Pohl CH,et al.Method for identification of Cryptococcus neoformans and Cryptococcus gattii useful in resource-limited settings[J].J Clin Pathol,2016,69(4):352-357.
[14] Bicanic T,Brouwer AE,Meintjes G,et al.Relationship of cerebrospinal fluid pressure,fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures[J].AIDS,2009,23(6):701-706.
[15] 鲁雁秋,黄晓婕,吴玉珊,等.203例艾滋病合并新型隐球菌性脑膜炎患者预后影响因素研究[J].中华神经医学杂志,2018,17(4):397-401.
[16] 鲁雁秋,邱丹,陈耀凯.艾滋病合并新型隐球菌性脑膜炎患者的综合治疗[J].中华临床感染病杂志,2018,11(2):156-160.
[17] Chastain DB,Henao-Martinez AF,Franco-Paredes C.Opportunistic invasive mycoses in AIDS:cryptococcosis,histoplasmosis,coccidiodomycosis,and talaromycosis[J].Curr Infect Dis Rep,2017,19(10):36.
[18] Eshun-Wilson I,Okwen MP,Richardson M,et al.Early versus delayed antiretroviral treatment in HIV-positive people with cryptococcal meningitis[J].Cochrane Database Syst Rev,2018,7:CD009012.
[19] Boulware DR,Meya DB,Muzoora C,et al.Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis[J].N Engl J Med.2014,370(26) 2487-2498.
[20] 孙继云,唐会云,徐新民,等.艾滋病合并隐球菌性脑膜炎70例临床分析[J].国际检验医学杂志,2017,38(19):2781-2782.
[21] 沈银忠,齐唐凯,张仁芳,等.艾滋病合并隐球菌脑膜炎的临床特点及预后[J].中华传染病杂志,2009,27(1):48-50.
[22] Liu ZY,Wang GQ,Zhu LP,et al.Expert consensus on the diagnosis and treatment of cryptococcal meningitis[J].Zhonghua Nei Ke Za Zhi,2018,57(5):317-323.
[23] Xu L,Zhang X,Guo Y,et al.Unique clinical features of cryptococcal meningitis among Chinese patients without predisposing diseases against patients with predisposing diseases[J].Med Mycol,2019,16.doi:10.1093/mmy/myy154.
[24] Xiao J,Gao G,Li Y,Zhang W,et al.Spectrums of opportunistic infections and malignancies in HIV-infected patients in tertiary care hospital,China[J].PLoS One,2013,8(10):e75915.