摘要： 目的 提高对获得性免疫缺陷综合征（艾滋病）合并神经系统损害临床特点的认识，以减少漏诊。方法 对28 例人类获得性免疫缺陷病毒（HIV）感染和（或）艾滋病患者中的12 例合并神经系统损害患者的临床资料和机会感染性疾病情况进行回顾，并结合文献分析总结。结果 12 例患者分别诊断为艾滋病脑病（5 例）、慢性脑膜炎（3 例）、周围神经病（表现为四肢远端对称性多发性神经病和获得性脱髓鞘性神经病各1 例）、脑梗死（1 例）和肌肉病（1 例）。艾滋病合并神经系统损害的发病率约为42.86%（12/28）。至少合并1 ~ 2 种以上机会性感染，以真菌最为多见，发病率为83.33%（10/12）；隐球菌性脑膜炎发病率为25%（7/28）。结论 HIV 感染可累及神经系统多个部位及肌肉。艾滋病期患者常合并多系统混合感染，以真菌最为常见；临床以消瘦、间歇性发热、头痛、咳嗽、认知功能减退、脑膜刺激征阳性等症状与体征为主，表现复杂多样，容易误诊或漏诊。诊断与鉴别诊断需依靠脑脊液检查、肺部CT、头部CT 和（或）MRI等辅助检查结果，临床工作中应注意筛查，尽早明确诊断。

关键词: 获得性免疫缺陷综合征, 机会性致病菌感染, 中枢神经系统感染

Abstract: Objective To deepen the understanding of clinical features of acquired immunodeficiency syndrome (AIDS) and reduce the rate of misdiagnosis. Methods Data of 12 patients with nervous system complications and opportunistics infection in 28 human immunodeficiency virus (HIV) infected persons and (or) AIDS patients were analysed retrospectively. The patients were admitted to our hospital from January 2007 to June 2011. Results Among the 12 patients, there were 5 cases of HIV encephalopathy, 3 chronic meningitis, 1 symmetrical polyneuropathy, 1 acquired demyelinating peripheral neuropathy, 1 cereboral infarction and 1 myopathy. The morbidity of HIV/AIDS complicated with nervous system lesion was 42.86% (12/28). Patients had 1 or 2 kinds of opportunistic infections. The morbidity rate of viral infection was 83.33% (10/12) while cryptococcal meningitis was 25% (7/28). Conclusion HIV infection may involve the muscle and multiple sites of nervous system. AIDS patients were often complicated with mixed infection, especially viral infection in multiple systems. The main signs and symptoms are emaciation, intermittent fever, headache, cough, cognitive deterioration and meningeal irritation sign. The presentations are complicated and may induce misdiagnosis and missed diagnosis. Cerebrospinal fluid, lung CT, head CT and (or) MRI and other accessory examinations should be performed for confirming diagnosis as soon as possible.

Key words: Acquired immunodeficiency syndrome, Opportunistic infections, Central nervous system infections