HIV 阴性隐球菌性脑膜炎合并 II 型糖尿病患者的临床特征和结局。
The clinical profiles and outcomes of HIV-negative cryptococcal meningitis patients in type II diabetes mellitus.
机构信息
Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.
Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.
出版信息
BMC Infect Dis. 2021 Feb 27;21(1):224. doi: 10.1186/s12879-021-05867-5.
BACKGROUND
The clinical profiles and outcomes of cryptococcal meningitis have been shown to vary depending on the underlying condition. The aim of this study was to investigate clinical characteristics and outcomes in patients with and without type II diabetes mellitus.
METHODS
A retrospective study was performed. Clinical data of HIV-negative cryptococcal meningitis patients with type II diabetes mellitus (n = 26) and without type II diabetes mellitus (n = 52) referring to the Jiangxi Chest Hospital between January 2012 to December 2018 were analyzed. The data were analyzed using chi square, none-parametric tests, and logistic regression. P-values < 0.05 were considered significant.
RESULTS
In this study, cryptococcal meningitis patients suffering from type II diabetes mellitus had a higher mortality (23.08% vs. 7.69%; P = 0.055), and required longer hospitalization (59.58 vs. 42.88 days; P = 0.132). Moreover, cerebrospinal fluid examinations revealed that cryptococcal meningitis patients with type II diabetes mellitus had higher opening pressure (271.54 vs. 234.23 mmHO; P = 0.125).The results of multivariate regression analysis revealed that cryptococcal meningitis patients with type II diabetes were more often presented with visual disorders (28.54% vs. 11.54%; [95% CI 0.056-0.705]; p = 0.012), and had higher cerebrospinal fluid protein levels (1027.62 ± 594.16 vs. 705.72 ± 373.88 mg/l; [95% CI 1.000-1.002]; p = 0.016). Among patients with type II diabetes mellitus, nausea and vomiting was more frequent at the initial visit in those died (100% vs. 50%; p = 0.027), and 66% of died type II diabetes mellitus patients were poorly controlled blood glucose level, compared with 30% in survival type II diabetes mellitus patients.
CONCLUSION
This study suggests that cryptococcal meningitis patients with type II diabetes mellitus differ significantly from cryptococcal meningitis patients without type II diabetes mellitus with respect to clinical symptoms such as visual disorders and cerebrospinal fluid examination. The presence of nausea and vomiting among type II diabetes mellitus patients could have implication in mortality.
背景
隐球菌性脑膜炎的临床特征和预后因基础疾病而异。本研究旨在探讨合并和不合并 2 型糖尿病的 HIV 阴性隐球菌性脑膜炎患者的临床特征和结局。
方法
回顾性研究。分析了 2012 年 1 月至 2018 年 12 月期间江西省胸科医院收治的 26 例合并 2 型糖尿病和 52 例不合并 2 型糖尿病的 HIV 阴性隐球菌性脑膜炎患者的临床资料。采用卡方检验、非参数检验和 logistic 回归进行数据分析。P 值<0.05 为差异有统计学意义。
结果
本研究中，合并 2 型糖尿病的隐球菌性脑膜炎患者死亡率更高（23.08%比 7.69%；P=0.055），住院时间更长（59.58 天比 42.88 天；P=0.132）。此外，脑脊液检查显示，合并 2 型糖尿病的隐球菌性脑膜炎患者的颅内压更高（271.54 毫米汞柱比 234.23 毫米汞柱；P=0.125）。多变量回归分析结果显示，合并 2 型糖尿病的隐球菌性脑膜炎患者更常出现视力障碍（28.54%比 11.54%；[95%CI 0.056-0.705]；P=0.012），脑脊液蛋白水平更高（1027.62±594.16 毫克/升比 705.72±373.88 毫克/升；[95%CI 1.000-1.002]；P=0.016）。在合并 2 型糖尿病的患者中，死亡患者就诊时恶心呕吐更为常见（100%比 50%；P=0.027），死亡患者中有 66%的血糖控制不佳，而存活患者中仅有 30%的血糖控制不佳。
结论
本研究表明，与不合并 2 型糖尿病的隐球菌性脑膜炎患者相比，合并 2 型糖尿病的隐球菌性脑膜炎患者在视觉障碍和脑脊液检查等临床症状方面存在显著差异。2 型糖尿病患者出现恶心呕吐可能与死亡率有关。
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