新型隐球菌性脑膜炎伴精神状态改变患者的免疫因素差异。
Differences in Immunologic Factors Among Patients Presenting with Altered Mental Status During Cryptococcal Meningitis.
作者信息
Lofgren Sarah, Hullsiek Kathy H, Morawski Bozena M, Nabeta Henry W, Kiggundu Reuben, Taseera Kabanda, Musubire Abdu, Schutz Charlotte, Abassi Mahsa, Bahr Nathan C, Tugume Lillian, Muzoora Conrad, Williams Darlisha A, Rolfes Melissa A, Velamakanni Sruti S, Rajasingham Radha, Meintjes Graeme, Rhein Joshua, Meya David B, Boulware David R
机构信息
University of Minnesota, Minneapolis, MN, USA.
Infectious Disease Institute, Makerere University, Kampala, Uganda.
出版信息
J Infect Dis. 2017 Mar 1;215(5):693-697. doi: 10.1093/infdis/jix033.
Abstract
Altered mental status in cryptococcal meningitis results in poorer survival, but underlying causes of altered mentation are poorly understood. Within two clinical trials, we assessed risk factors for altered mental status (GCS score<15) considering baseline clinical characteristics, CSF cytokines/chemokines, and antiretroviral therapy. Among 326 enrolled participants, 97 (30%) had GCS<15 and these patients had lower median CSF cryptococcal antigen titers (P = .042) and CCL2 (P = .005) but higher opening pressures (320 vs. 269 mm H2O; P = .016), IL-10 (P = .044), and CCL3 (P = .008) compared with persons with GCS=15. Altered mental status may be associated with host immune response rather than Cryptococcus burden.
摘要
隐球菌性脑膜炎患者精神状态改变会导致生存率降低，但精神状态改变的潜在原因尚不清楚。在两项临床试验中，我们根据基线临床特征、脑脊液细胞因子/趋化因子和抗逆转录病毒疗法评估了精神状态改变（格拉斯哥昏迷评分<15分）的危险因素。在326名登记参与者中，97名（30%）格拉斯哥昏迷评分<15分，与格拉斯哥昏迷评分为15分的患者相比，这些患者的脑脊液隐球菌抗原滴度中位数较低（P = 0.042）和CCL2水平较低（P = 0.005），但初压较高（320 vs. 269 mm H2O；P = 0.016）、IL-10水平较高（P = 0.044）和CCL3水平较高（P = 0.008）。精神状态改变可能与宿主免疫反应而非隐球菌负荷有关。
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