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目的评估隐球菌相关特异性实验室指标的诊断意义。方法对2010年1月至2014年8月北京佑安医院收治的56例合并隐球菌感染的艾滋病(AIDS)病人的实验室指标进行回顾性研究。结果 56例AIDS合并隐球菌脑膜脑炎病人中,50例为实验室确诊,6例为临床诊断。CD+4T淋巴细胞(简称CD4细胞)计数中位数为16个/mm3(四分位区间:3~56),73.2%(41/56)病人的CD4细胞<50个/mm3。92.9%病人有颅内高压(≥200mmH2O),最高达570mmH2O。17例(30.4%)病人的脑脊液(CSF)蛋白>2g/L,最高达13.7g/L,94.6%病人的CSF细胞数<50×106/L。56例病人中墨汁染色阳性的41例(73.2%),脑脊液和血中隐球菌抗原检测的灵敏度分别为89.3%(50人)及85.7%(48人)。用CSF隐球菌抗原作为参照,墨汁染色的灵敏度为82.0%(41/50)和特异性为100%(41/41)。治疗前后颅内高压及脑脊液蛋白显著降低(P<0.01)。结论实验室检查对隐球菌早期诊断治疗至关重要,建议对临床疑似合并中枢神经系统感染的所有AIDS病人广泛开展快速、方便的隐球菌乳胶凝集试验抗原早期筛查,从而实施早期诊断治疗,降低病死率。
Objective To evaluate the diagnostic significance of Cryptococcus specific laboratory markers. Methods A retrospective study was conducted on laboratory data of 56 AIDS patients with cryptococcal infection admitted to Beijing You’an Hospital from January 2010 to August 2014. Results Of the 56 AIDS-refractory meningococcal meningoencephalitis patients, 50 were diagnosed clinically and 6 were clinically diagnosed. The median CD + 4T lymphocyte count (CD4 cell count) was 16 per mm3 (quartile: 3 to 56) and 73.2% (41/56) of patients had <50 cells / mm3.92.9% of patients Have intracranial hypertension (≥ 200mmH2O), up to 570mmH2O. Seventeen (30.4%) patients had a cerebrospinal fluid (CSF) protein> 2 g / L, up to 13.7 g / L, and 94.6% of patients had CSF counts <50 × 10 6 / L. In 56 cases, 41 cases (73.2%) had ink stain positive, and 89.3% (50) and 85.7% (48) in cerebrospinal fluid and cryptococcal blood respectively. With CSF Cryptococcal antigen as a reference, ink stains had a sensitivity of 82.0% (41/50) and a specificity of 100% (41/41). Intracranial hypertension and cerebrospinal fluid protein were significantly decreased before and after treatment (P <0.01). Conclusions Laboratory tests are crucial for the early diagnosis and treatment of cryptococcosis. It is suggested that early and timely diagnosis and treatment of Cryptococcal latex agglutination test antigen should be carried out in all AIDS patients with clinical suspected central nervous system infection. Case fatality rate.