Effect of lumbar drainage on HIV-positive cryptococcal meningitis

Abstract

Objective To explore whether different drainage methods have positive effects on HIV positive patients with c:ryptoc:oc:c:al meningitis (CM). Methods From January 2017 to December 2019, 40 patients with HIV positive CM were treated in the Department of Infectious Diseases of the First Affiliated Hospital of Guangxi Medical University and Nanning Infectious Diseases Hospital Affiliated to Guangxi Medical University. 20 patients with continuous lumbar drainage were selected as the observation group and 20 patients with regular lumbar puncture drainage were enrolled into the control group. The clinical manifestations, CD4 count, cerebrospinal fluid examination and cryptococcal ink staining results of patients before and after treatment were recorded. Results There was no significant difference in general data between the two groups before treatment ( P >0.05). After treatment, the white blood cell count [(28.70±12.04)x10 6 /L vs (68.80±34.71) x10 6 /L] and protein content [(477.25±198.61) mg/L vs (712.15±427.89) mg/L] in cerebrospinal fluid decreased significantly in the observation group, and similar results were found in the control group ( P 0.05)。治疗后观察组中脑脊液白细胞计数[(28.70±12.04)x10 6 /L]、蛋白含量[(477.25±198.61) mg/L]比治疗前[(68.80±34.71)x10 6 /L、（712.15±427.89) mg/L]明显下降( P <0.001), 对照组中也有相似的结果( P <0.05), 治疗后两组患者脑脊液的CD4计数[观察组(31.30±22.00)cells/μL、对照组(27.70±20.18)cells/μL]、糖含量[观察组(3.41±0.62)mmol/L、对照组（2.80±0.77) mmol/L]、氯化物[观察组（127.78±9.47)mmol/L、对照组（125.25±8.03) mmol/L]均较治疗 前升髙( P <0.05)。治疗后两组患者间CD4/CD8、白细胞计数、糖含量差异有统计学意义( P <0.05)。治疗后观察组头痛、恶心/呕吐症状较对照组改善更明显。最终 , 腰椎持续引流方式治疗有效15例, 无效5例;定期腰椎穿刺引流治疗7例 有效。 结论 腰椎持续引流方式治疗隐球菌性脑膜炎, 能较快缓解临床症状, 加快脑脊液的更新, 缩短病原菌清除时 间, 值得临床推广应用