目的 探讨HIV感染及AIDS患者群(HIV/AIDS)的各种中枢神经系统机会性感染(opportunistic infections,OIs)情况,以提高诊断水平及临床治愈率,改善预后.方法 统计73例HIV/AIDS中枢神经系统OIs的临床数据,分析其临床表现、实验室检查结果和头颅影像学表现,评价其疗效及预后.结果 73例HIV/AIDS的中枢神经系统OIs中,新型隐球菌性脑膜炎36例(49.3％),弓形体脑炎18例(24.7％),结核性脑膜炎5例(6.8％),HIV脑病5例(6.8％),进行性多灶性脑白质病4例(5.5％),巨细胞病毒性脑炎3例(4.1％),原因不明急性脑梗死2例(2.7％).好转47例,占64.3％;死亡8例,占11.0％;病情无改善、自动出院18例,占24.7％.结论 HIV/AIDS中枢神经系统的OIs诊断困难,病死率高.HIV/AIDS患者,尤其是CD4+T淋巴细胞计数＜200/μl者,一旦出现中枢神经系统症状,应尽早进行脑脊液及头颅影像学等相关检查,如条件允许,行脑活体组织检查更有助于明确诊断.早诊断、早治疗是降低HIV/AIDS各种中枢神经系统OIs病死率以及提高治愈率的关键.%Objective To investigate the opportunistic infections (Ois) of central nervous system in HIV/AIDS patients so as to increase the diagnostic level and the curative rate, and improve the prognosis. Methods Clinical data of 73 AIDS patients complicated with the Ois of central nervous system were collected, the clinical menifestations, laboratory test results and head CT or MRI findings were analyzed, and the treatment efficacy and the prognosis were evaluated. Results Among the 73 patients, 36 (49.3%) were complicated with cryptoeocal meningitis, 18 (24.7%) with toxoplasmosis, 5 (6.8%) with tuberculous meningitis, 5 (6.8% ) with HIV encephalopathy, 4 (5.5%) with progressive multifocal leukoencephalopathy, 3 (4.1%) with CMV encephalitis and 2 (2.7%) with cerebral infarction of unknown reason. Totally 47 patients (64.3%) recovered completely or improved partially, 8 (11.0%) deceased, and 18 (24.7%) had no improvement and were discharged from hospital. Conclusions The Ois of central nervous system in HIV/AIDS patients are difficult to diagnose with a high mortality rate. If HIV/AIDS patients, especially those whose CD4+ T lymphocyte counts are lower than 200 cells/μl, have the symptoms of central nervous system disorders, it is crucial to undergo cerebrospinal fluid and head CT or MRI examination, and to make definite diagnosis as early as possible (brain biopsy is more helpful if conditions permit). Early diagnosis and early treatment are the key for decreasing the mortality rate and improving the curative rate.
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