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| AIDS合并新型隐球菌感染患者的临床特点分析 |
| Analysis on clinical characteristics of AIDS patients with Cryptococcal neoformans infection |
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| DOI：10.3969/j.issn.1007-8134.2019.05.009 |
| 中文关键词: 新型隐球菌 临床表现 药物敏感性 |
| 英文关键词: Cryptococcus neoformans clinical manifestations drug sensitivity |
| 基金项目:新发突发传染病研究北京市重点实验室开放课题（DTKF201801） |
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| 中文摘要: |
| 目的 了解AIDS合并新型隐球菌感染患者的临床表现及病原菌对5种抗真菌药物的敏感性特点。方法 收集并分析首都医科大学附属北京地坛医院2009年1月—2018年6月诊断明确的74例AIDS合并新型隐球菌感染患者的临床表现，CD4+、CD8+ T细胞计数和脑脊液检测情况等资料；采集患者的血液、脑脊液和肺泡灌洗液等不同类型标本进行培养和鉴定；并对分离菌株进行5种抗真菌药物的敏感性试验。结果 74例AIDS合并新型隐球菌感染患者均经过病原学确诊，临床表现无特异性，大部分患者以发热、头痛、呕吐为主，68.91%（51/74）的患者脑脊液压力≥200 mmH2O；临床使用的抗真菌药物主要是两性霉素B、5-氟胞嘧啶和氟康唑，大部分患者转归较好；对60株分离的新型隐球菌进行药物敏感性分析，结果显示，5-氟胞嘧啶和氟康唑敏感率分别是91.67%和83.33%。结论 AIDS合并新型隐球菌感染患者的临床表现以头痛、发热为主，脑脊液压力大部分偏高；新型隐球菌对多种抗真菌药敏感，临床主要采用两性霉素B、5-氟胞嘧啶和氟康唑进行治疗，可根据不同的疾病阶段采取不同的联合用药方案。 |
| 英文摘要: |
| Objective To understand the clinical manifestations of AIDS patients with Cryptococcal neoformans infection and the drug sensitivity of pathogenic bacteria to 5 antifungal drugs. Methods Clinical manifestations of 74 AIDS patients with Cryptococcal neoformans infection who were definitely diagnosed in Beijing Ditan Hospital affiliated to Capital Medical University from January 2009 to June 2018 were collected and analyzed. CD4+, CD8+ T cell count and cerebrospinal fluid test were also analyzed. Different specimens such as blood, cerebrospinal fluid and alveolar lavage fluid were collected for culture and identification and the isolates were tested for the sensitivity to 5 antifungal drugs. Results Seventy-four AIDS patients with Cryptococcal neoformans infection were all diagnosed by pathogens, and the clinical manifestations were non-specific. Most patients had fever, headache, and vomiting as the main clinical manifestations and 68.91% (51/74) cases had cerebrospinal fluid pressure≥200 mmH2O. The antifungal drugs used in clinic were mainly amphotericin B, 5-fluorocytosine and fluconazole. Most of the patients had better outcomes. The drug sensitivity analysis of 60 strains of Cryptococcus neoformans showed that the sensitivity rates of 5-fluorocytosine and fluconazole were 91.67% and 83.33%, respectively. Conclusions Headache and fever are the major clinical manifestations of AIDS patients with Cryptococcal neoformans infection and cerebrospinal fluid pressure is mostly high. Cryptococcus neoformans is sensitive to many antifungal drugs. The main antifungal drugs used in clinic are amphotericin B, 5-fluorocytosine and fluconazole. Different combination regimens can be adopted according to different disease stages. |
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