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目的观察不同治疗方案治疗艾滋病合并新型隐球菌脑膜炎(CM)的临床疗效。方法将艾滋病合并CM患者46例分为两组,观察组25例采用两性霉素B和氟康唑静脉滴注,同时辅以两性霉素B加地塞米松鞘内注药;对照组21例仅采用两性霉素B和氟康唑静脉滴注,观察两组患者的疗效。结果经过6周治疗,观察组中临床症状明显好转,复查脑脊液墨汁染色试验阴性17例(68.0%);死亡4例,病死率16.0%;临床症状好转,但复查脑脊液墨汁染色试验仍阳性4例。对照组中临床症状明显好转,复查脑脊液墨汁染色试验阴性11例(52.4%);死亡6例,病死率28.6%;临床症状好转,但复查脑脊液墨汁染色试验仍阳性4例。死亡病例CD4+T细胞计数<100个/μl。两组病死率及治疗后脑脊液墨汁染色阴转率比较,差异均无统计学意义(P>0.05)。结论 CD4+T细胞计数低下的艾滋病合并CM患者病死率高,全身应用抗真菌药物的同时辅以鞘内注药的疗效未见明显优势。
Objective To observe the clinical effects of different treatment regimens in treating AIDS with cryptococcal meningitis (CM). Methods 46 AIDS patients with CM were divided into two groups. The observation group 25 patients were treated with amphotericin B and fluconazole intravenously, supplemented with amphotericin B plus dexamethasone intrathecal injection; the control group of 21 patients The use of amphotericin B and fluconazole intravenous infusion, the efficacy of two groups of patients. Results After 6 weeks of treatment, the clinical symptoms in the observation group were significantly improved. The negative results of cerebrospinal fluid ink staining were negative in 17 cases (68.0%), 4 died and the case fatality rate was 16.0%. The clinical symptoms were still improved. However, the cerebrospinal fluid ink stain test was still positive in 4 cases . In the control group, the clinical symptoms were significantly improved. The cerebrospinal fluid ink stain test was negative in 11 cases (52.4%), 6 died and the case fatality rate was 28.6%. The clinical symptoms improved. However, 4 cases were still positive in cerebrospinal fluid ink stain test. Deaths CD4 + T cell count <100 / μl. There was no significant difference between the two groups in mortality and the rate of ink stain in cerebrospinal fluid after treatment (P> 0.05). Conclusion The AIDS patients with low CD4 + T cell count have a high case fatality rate in patients with CM. There is no obvious advantage in using systemic antifungal drugs combined with intrathecal injection.