目的 对比分析艾滋病和非艾滋病患者隐球菌脑膜炎(CNM)的临床特点及治疗效果，为临床诊疗提供参考。方法 回顾性分析2012年1月至2017年1月四川大学华西医院收治的CNM患者共73例（非艾滋病CNM患者30例，艾滋病CNM患者43例）。比较两组患者的临床表现、辅助检查结果、治疗方案及临床转归。结果 两组患者均表现头痛、发热、恶心呕吐等非特异性症状。与艾滋病CNM组相比，非艾滋病CNM组脑脊液中有核细胞及蛋白含量高（P=0.000，P=0.041），初次脑脊液墨汁染色阳性率更低（70.0% vs. 93.0%，P=0.009），误诊率更高（43.3% vs. 14.0%，P=0.005）；住院时间更长〔（112.27±105.42） d vs. （52.64±39.17） d；P<0.05〕；在抗真菌治疗过程中不良反应的发生率更高（80% vs. 30.2%，P=0.000）。而在艾滋病组中，40例患者（93%）首次确诊艾滋病并未行抗病毒治疗，治疗效果较非艾滋病CNM组差，病死率更高（30.2% vs. 13.4%，P=0.000）。结论 CNM诊疗困难，在不同免疫状况的人群中表现有差异，预后差，建议合并艾滋病的患者在抗病毒治疗前及时行抗真菌治疗。
英文摘要:
ObjectiveTo compare clinical characteristics and therapeutic outcomes between HIV and non-HIV patients with Cryptococcus neoformans meningitis (CNM). Methods A total of 73 patients with CNM (30 patients without HIV and 43 with HIV) were admitted from January 2012 to January 2017. The clinical manifestations, biochemical and microbiological characteristics of cerebrospinal fluid (CSF) were collected and analyzed. Results The patients in the two group displayed non-specific symptoms such as headache, fever, nausea and vomiting. Non-HIV CNM patients had more serious inflammatory reaction with higher karyocytes and protein level （P=0.000, P=0.041, respectively), while had lowere positive rate of primary ink staining in cerebrospinal fluid (70.0% vs. 93.0%, P=0.009), higher misdiagnosis rate (43.3% vs. 14.0%, P=0.005), longer hospitalization duration 〔(112.27±105.42) d vs. (52.64±39.17) d, P=0.021〕, higher adverse reactions rate of antifungal treatment was (80.0% vs. 30.2%, P=0.000). However, in HIV CNM patients, 40 (93.0%) patients did not receive antiviral therapy before and were diagnosed as AIDS for the first time; the therapeutic effect in this group was very poor with higher mortality (30.2% vs. 13.4%, P=0.000). Conclusion Immunity status should be considered in the diagnosis and treatment of CNM, since it is difficult to diagnose with long treatment period and poor prognosis.
