血清隐球菌抗原筛查在不同 CD4 细胞计数范围内 HIV 感染患者中对隐球菌病的早期诊断作用。

The role of serum cryptococcal antigen screening for the early diagnosis of cryptococcosis in HIV-infected patients with different ranges of CD4 cell counts.

机构信息

Department of Medicine, Division of Infectious Diseases, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok 10400, Thailand.

出版信息

J Infect. 2010 Jun;60(6):474-7. doi: 10.1016/j.jinf.2010.03.015. Epub 2010 Mar 27.

DOI:10.1016/j.jinf.2010.03.015

PMID:20347868

Abstract

OBJECTIVE

To determine the role of serum cryptococcal antigen (SCA) for the screening of cryptococcosis in HIV-infected patients with different ranges of CD4 cell counts.

METHODS

A retrospective cohort study was conducted in antiretroviral-naïve HIV-infected patients who had no symptom and had been screened with SCA in a tertiary-care hospital. Prevalence of positive SCA at different ranges of CD4 cell counts, risk factor of positive SCA, and incidence of cryptococcosis during one-year follow-up period after negative SCA were determined.

RESULTS

There were 131 patients with a mean age of 38.5 years; 61.8% were male. Median (range) CD4 was 62 (3-590) cells/mm(3). The overall prevalence of positive SCA was 9.2%. This prevalence in patients with CD4 < 100, 100-199, and >or=200 cells/mm(3) were 12.9%, 3.6%, and 0%, respectively (P = 0.041). In multivariate analysis, CD4 < 100 cells/mm(3) was associated with positive SCA (OR = 6.69; 95% CI, 1.03-23.56). Four (33.3%) of 12 patients with positive SCA had cryptococcosis whereas one (0.8%) of 119 patients with negative SCA developed meningitis at one-year follow-up.

CONCLUSIONS

SCA screening has a substantial role for the early detection of cryptococcal infection in HIV-infected patients with low CD4 cell counts. Routine screening with SCA should be performed in patients with CD4 < 100 cells/mm(3).

摘要

目的

确定血清隐球菌抗原（SCA）在不同 CD4 细胞计数范围内的 HIV 感染患者中筛查隐球菌病的作用。

方法

对一家三级保健医院进行了一项回顾性队列研究，研究对象为无症状且接受过 SCA 筛查的抗逆转录病毒初治 HIV 感染患者。确定不同 CD4 细胞计数范围内 SCA 阳性的患病率、SCA 阳性的危险因素以及 SCA 阴性后一年随访期间隐球菌病的发生率。

结果

共纳入 131 例患者，平均年龄 38.5 岁，61.8%为男性。中位（范围）CD4 为 62（3-590）个细胞/mm3。SCA 阳性的总患病率为 9.2%。CD4<100、100-199 和≥200 个细胞/mm3 的患者中 SCA 阳性的患病率分别为 12.9%、3.6%和 0%（P=0.041）。多变量分析显示，CD4<100 个细胞/mm3 与 SCA 阳性相关（OR=6.69；95%CI，1.03-23.56）。12 例 SCA 阳性患者中有 4 例（33.3%）发生了隐球菌病，而 119 例 SCA 阴性患者中有 1 例（0.8%）在一年随访时发生了脑膜炎。