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目的探讨艾滋病合并结核性脑膜炎(TBM)的临床特征、诊断和治疗,提高艾滋病合并TBM的认识。方法回顾性总结1999年1月—2009年12月收治的32例艾滋病合并TBM的临床资料。结果发热30例、头痛29例、意识障碍18例、抽搐12例,脑膜刺激征25例,咳嗽27例,咳痰25例。不同程度存在艾滋病相关表现。常合并肺结核(75%)及其他肺外结核(12.5%)。所有病例CD4<200/mm3。脑脊液压力升高,白细胞升高,蛋白质升高,糖降低,氯化物降低,ADA升高。结论艾滋病合并TBM临床表现复杂,无特异性,病情重,致残率高,死亡率高。治疗上抗结核治疗+激素,适时联合HARRT治疗可降低病死率,提高生活质量,延长生命。
Objective To explore the clinical features, diagnosis and treatment of AIDS complicated with tuberculous meningitis (TBM) and to improve the understanding of AIDS complicated with TBM. Methods The clinical data of 32 AIDS patients with TBM admitted from January 1999 to December 2009 were retrospectively reviewed. Results 30 cases of fever, headache in 29 cases, 18 cases of disturbance of consciousness, convulsions in 12 cases, 25 cases of meningeal irritation, cough in 27 cases, sputum in 25 cases. There are different levels of AIDS-related performance. Often combined with tuberculosis (75%) and other extrapulmonary tuberculosis (12.5%). All cases CD4 <200 / mm3. Cerebrospinal fluid pressure, leukocytosis, elevated protein, decreased glucose, chloride decreased, ADA increased. Conclusion The clinical manifestations of AIDS complicated with TBM are complex, nonspecific, severe illness, high morbidity and high mortality. Treatment of anti-TB therapy + hormones, timely combination of HARRT treatment can reduce mortality, improve quality of life and prolong life.