两性霉素B联合氟康唑治疗艾滋病合并新型隐球菌性脑膜脑炎的疗效预测因素分析

目的:探讨两性霉素B联合氟康唑治疗艾滋病合并新型隐球菌性脑膜脑炎(简称"艾滋病合并隐脑")的疗效预测因素。方法:回顾性收集2010年1月1日-2016年12月31日58例在首都医科大学附属北京佑安医院住院治疗且接受两性霉素B联合氟康唑治疗的艾滋病合并隐脑患者的临床资料,分析其疗效预测因素及预测价值。结果:根据预后将患者分为好转组(38例)和死亡组(20例),单因素分析结果显示两组之间CD4+T细胞计数、脑脊液细胞计数比较有统计学差异(P分别为0.032,0.001)。Logistic回归多因素分析结果显示脑脊液细胞计数是两性霉素B联合氟康唑治疗艾滋病合并隐脑的疗效预测因素(P=0.023),Exp(B)=1.01,95%置信区间为1.00-1.03。ROC曲线对脑脊液细胞计数的预测价值进行分析,结果显示曲线下面积为0.889,预测阈值为261个/mm3,对应的敏感性=0.684,特异性=1.0。结论:脑脊液细胞计数是两性霉素B联合氟康唑治疗艾滋病合并新型隐球菌性脑膜脑炎良好的疗效预测参考因素。

Analysis of the Efficacy Prediction Factors for AIDS Patients with Cryptococcal Meningoencephalitis Treated by Amphotericin B Combined with Fluconazole

ABSTRACT Objective: To investigate the efficacy prediction factors of amphotericin B combined with fluconazole for AIDS Patients with Cryptococcal meningoencephalitis. Methods: The clinical data of 58 cases of AIDS patients with cryptococcal meningoencephalitis from Beijing You''an Hospital during 1st January 2010 and 31st December 2016 treated by amphotericin B combined with fluconazole were selected, the prediction factors and their value were analyzed. Results: The patients were divided into two groups by the outcome, 38 patients recovered and 20 patients died. There were statistical significances in the counts of serum CD4⁺T cells and cerebrospinal fluid cells between groups from univariates analysis. Logistic regression showed that the count of cerebrospinal fluid cells was efficacy prediction factor. The ROC analysis showed that the sensitivity and specificity were 0.684 and 1.0 for 261 /mm³ of cerebrospinal fluid cells, and area under curve was 0.889. Conclusion: The count of cerebrospinal fluid cells is a good efficacy prediction factor of amphotericin B combined with fluconazole for AIDS Patients with Cryptococcal meningoencephalitis.