艾滋病合并新型隐球菌性脑膜脑炎的死亡危险因素分析
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摘要
目的探讨艾滋病合并新型隐球菌性脑膜脑炎(cryptococcus neoformans meningitis, CM)的死亡危险因素。方法回顾性分析2010年1月至2016年12月于首都医科大学附属北京佑安医院住院治疗的67例艾滋病合并CM患者的临床资料,根据转归分为死亡组(n=20)和非死亡组(n=47)。首先对可能的危险因素进行单因素分析,包括性别、年龄、临床症状和体征、脑脊液检查(脑脊液压力、蛋白、细胞计数等)、CD4~+T细胞计数、诱导期抗真菌方案等。然后对两组间差异有统计学意义的危险因素进行多因素logistic回归分析,明确死亡的危险因素。结果单因素分析显示,两组间CD4~+T细胞计数、脑脊液压力、诱导期抗真菌药物差异有统计学意义。多因素logistic回归分析显示,CD4~+T细胞计数和脑脊液压力与死亡具有相关性,其他指标与死亡无相关性。CD4~+T细胞计数31.9个/μl为判定死亡的阈值,敏感性和特异性分别为0.85和0.83;脑脊液压力为245 mmH_2O(1 mmH_2O=0.009 8 kPa)时可作为判定死亡的阈值,敏感性和特异性分别为0.75和0.74。结论基线CD4~+T细胞计数、脑脊液压力是艾滋病合并CM的死亡危险因素。
Objective To analyze the risk factors of death in AIDS patients with cryptococcus neoformans meningitis(CM).Methods Sixty-seven AIDS patients with CM were collected from January 2010 to December 2016, and followed up for one year. Patients were divided into Death group(n=20) and Non-death group(n=47). Potential risk factors were compared between two groups, including gender, age, clinical characteristics, examination of cerebrospinal fluid(pressure, protein, cell count, etc.), CD4~+ T count and antifungal therapy in induction period. The items with statistic difference were analyzed to determine the risk factors of death by logistic regression. Results There were statistical differences in CD4~+ T cell count, cerebrospinal fluid pressure and antifungal therapy in induction period between two groups. The results of further analysis from logistic regression showed that, only CD4~+ T cell count and cerebrospinal fluid pressure were risk factors of death for AIDS patients with CM. When the threshold value of CD4~+ T cell count for death was 31.9 cell/μl, the sensitivity and specificity was 0.85 and 0.83, respectively. When the threshold value of cerebrospinal fluid pressure for death was 245 mmH_2O(1 mmH_2O =0.009 8 kPa), the sensitivity and specificity was 0.75 and 0.74, respectively. Conclusions Baseline CD4~+ T cell count and cerebrospinal fluid pressure are risk factors of death for AIDS with CM.
Objective To analyze the risk factors of death in AIDS patients with cryptococcus neoformans meningitis(CM).Methods Sixty-seven AIDS patients with CM were collected from January 2010 to December 2016, and followed up for one year. Patients were divided into Death group(n=20) and Non-death group(n=47). Potential risk factors were compared between two groups, including gender, age, clinical characteristics, examination of cerebrospinal fluid(pressure, protein, cell count, etc.), CD4~+ T count and antifungal therapy in induction period. The items with statistic difference were analyzed to determine the risk factors of death by logistic regression. Results There were statistical differences in CD4~+ T cell count, cerebrospinal fluid pressure and antifungal therapy in induction period between two groups. The results of further analysis from logistic regression showed that, only CD4~+ T cell count and cerebrospinal fluid pressure were risk factors of death for AIDS patients with CM. When the threshold value of CD4~+ T cell count for death was 31.9 cell/μl, the sensitivity and specificity was 0.85 and 0.83, respectively. When the threshold value of cerebrospinal fluid pressure for death was 245 mmH_2O(1 mmH_2O =0.009 8 kPa), the sensitivity and specificity was 0.75 and 0.74, respectively. Conclusions Baseline CD4~+ T cell count and cerebrospinal fluid pressure are risk factors of death for AIDS with CM.
引文
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[9]姚志文,鲁翔,沈冲,等.两性霉素B联合氟胞嘧啶或氟康唑治疗艾滋病相关隐球菌脑膜炎效果的Meta分析[J].中华传染病杂志,2014,32:353-356.
[10]Sloan D,Dlamini S,Paul N,et al.Treatment of acute cryptococcal meningitis in HIV infected adults,with an emphasis on resource-limited settings[J].Cochrane Database Syst Rev,2008,4:CD005647.
[11]吴吉芹,徐斌,区雪婷,等.非艾滋病相关隐球菌脑膜炎的预后因素分析[J].中华医学杂志,2010,90:33-37.
[2]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(2015版)[J].中华临床感染病杂志,2015,8:385-401.
[3]宋旸,矫黎东,王宪玲,等.新型隐球菌脑膜炎24例临床分析[J].北京医学,2017,39:464-467.
[4]薛成莲,马剡芳.艾滋病并发新型隐球菌脑膜炎28例临床分析[J].临床和实验医学杂志,2018,17:1147-1149.
[5]Liao CH,Chi CY,Wang YJ,et al.Different presentations and outcomes between HIV-infected and HIV-uninfected patients with cryptococcal meningitis[J].J Microbiol Immunol Infect,2012,45:296-304.
[6]Rhodes J,Beale MA,Vanhove M,et al.A population genomics approach to assessing the genetic basis of within-host microevolution underlying recurrent cryptococcal meningitis infection[J].G3:Genes,Genomes,Genetics,2017,7:1165-1176.
[7]Perfect JR,Dismukes WE,Dromer F,et al.Clinical practice guidelines for the management of cryptococcal disease:2010 update by the infectious diseases society of america[J].Clin Infect Dis,2010,50:291-322.
[8]de Carvalho Santana R,Schiave LA,Dos Santos Quaglio AS,et al.Fluconazole Non-susceptible cryptococcus neoformans,relapsing/refractory cryptococcosis and long-term use of liposomal amphotericin B in an AIDS patient[J].Mycopathologia,2017,182:855-861.
[9]姚志文,鲁翔,沈冲,等.两性霉素B联合氟胞嘧啶或氟康唑治疗艾滋病相关隐球菌脑膜炎效果的Meta分析[J].中华传染病杂志,2014,32:353-356.
[10]Sloan D,Dlamini S,Paul N,et al.Treatment of acute cryptococcal meningitis in HIV infected adults,with an emphasis on resource-limited settings[J].Cochrane Database Syst Rev,2008,4:CD005647.
[11]吴吉芹,徐斌,区雪婷,等.非艾滋病相关隐球菌脑膜炎的预后因素分析[J].中华医学杂志,2010,90:33-37.