关键词: HIV感染, 结核, 脑膜, 疾病特征, 预后, 危险因素, 因素分析, 统计学

Abstract:

Objective To analyze the clinical characteristics, short-term prognosis and influencing factors of patients with human immunodeficiency virus (HIV) infection complicated with tuberculous meningitis (TBM).Methods One hundred and forty-eight cases of TBM patients were retrospectively collected from Chengdu Public Health Clinical Medical Center between January 2017 and December 2017. Among them, 52 were infected with HIV (HIV+/TBM group) and 96 were not infected with HIV (HIV-/TBM group). The clinical manifestations, cerebrospinal fluid (CSF) examination results, skull imaging and clinical outcomes of the patients in the two groups were compared.Results The incidences of malnutrition, anemia, and complication with other extrapulmonary tuberculosis in the HIV+/TBM group were 78.8% (41/52), 51.9% (27/52), and 73.1% (38/52), respectively, which were higher than those in the HIV-/TBM group (39.6% (38/96), 30.2% (29/96), and 30.2% (29/96)), and the differences were statistically significant (χ ² values were 20.89, 6.76, and 8.27; P values were <0.05). The median (quartile) of CSF pressure, white cell count, protein content, sugar and chloride levels were 185.0 (141.0, 225.0) mm H₂O (1mm H₂O=0.0098 kPa), 30.0 (4.0, 175.0)×10 ⁶/L, 1141.2 (762.8, 1548.6) mg/L, 2.3 (1.7, 2.7) mmol/L, and 117.0 (111.1, 121.9) mmol/L in the HIV+/TBM group and 284.0 (197.5, 315.0) mm H₂O, 360.0 (280.0, 415.0)×10 ⁶/L, 1660.0 (1270.0, 1900.0) mg/L, 1.4 (1.2, 1.8) mmol/L, and 105.1 (102.6, 112.4) mmol/L in the HIV-/TBM group; the differences were statistically significant (Z values were 3.63, 4.79, 2.57, 4.17, and 4.19; P values were <0.05). The incidence of cerebral infarction was 46.2% (24/52) in the HIV+/TBM group and 28.1% (27/96) in the HIV-/TBM group; the difference was statistically significant (χ ²=4.85, P=0.028). In the HIV+/TBM group, 20 cases (38.5%) improved and 32 cases (61.5%) deteriorated or died at discharge, and in the HIV-/TBM group, 62 cases (64.6%) improved and 34 cases (35.4%) deteriorated or died, showing significant difference (χ ²=9.32, P<0.05). In the HIV+/TBM group, among the patients who deteriorated or died, patients with BMI<18,severe anemia (hemoglobin <60g/L), CD4 ⁺T lymphocyte count <50/μl, standard anti-tuberculosis treatment and standard antiviral treatment accounted for 56.3% (18/32), 43.8% (14/32), 53.1% (17/32), 28.1% (9/32), and 40.6% (13/32), respectively, and those among patients who improved accounted for 25.0% (5/20), 15.0% (3/20), 20.0% (4/20), 60.0% (12/20), and 75.0% (15/20), showing significant differences (χ ²=4.87, 4.62, 5.61, 5.19, and 5.85, respectively, all P<0.05). Multivariate logistic regression analysis showed that CD4 ⁺T lymphocyte count <50/μl (OR(95%CI)=4.21(1.15-15.45)) was risk factor, whereas receiving standard anti-tuberculosis (OR(95%CI)=0.28(0.05-0.94)) and standard antiviral therapy (OR(95%CI)=0.13(0.04-0.47)) were protective factor for the prognosis of patients. Conclusion HIV infected TBM patients are more likely to have altered clinical manifestations, CSF indexes, cranial imaging and prognosis. Timely initiation of standardized anti-tuberculous treatment and anti-viral therapy could improve the prognosis of patients.

Key words: HIV infections, Tuberculosis, meningeal, Disease attributes, Prognosis, Risk factors, Factor analysis, statistical