隐球菌脑膜炎34例临床分析  

Clinical Analysis on 34 Cases of Cryptococcal Meningitis

作　　者：龚细礼[1] 黄立[1] 杜芬[1] 

机构地区：[1]湖南师范大学附属湘东医院,湖南醴陵412200

出　　处：《医学临床研究》2008年第2期283-284,共2页Journal of Clinical Research

摘　　要：【目的】总结新型隐球菌脑膜炎患者临床特点和诊断、误诊及治疗的经验。【方法】对本院2000年1月至2007年8月期间确诊的隐球菌脑膜炎患者34例临床资料进行回顾分析。【结果】患者以中青年多见。46%患者既往患慢性乙肝、肝硬化、糖尿病、肺部真菌病、肾病综合征等疾患。误诊率达52.9%,主要误诊为结核性脑膜炎、病毒性脑膜炎、化脓性脑膜炎。治疗以二性霉素B(AMB)联用氟康唑(FLU)为主。【结论】隐球菌脑膜炎早期临床表现不典型,极易误诊,提高对本病的认识和警惕,及时反复多次脑脊液涂片检查是关键。AMB联合FLU为隐球菌脑膜炎的主要治疗方案。[Objective] To summarize the clinical characteristics,the causes of misdiagnosis,the methods of diagnosis and therapy o{ Cryptococcus neoformans meningitis （CNM）. [Methods] Clinical data of 34 cases OF CNM diagnosed by etiological methods from January 2000 to August 2007 were reviewed and analyzed. [Resultsl Most of cases were middle-aged or young patients, 46% of which had chronic type B hepatitis, hepatic cirrhosis, diabetes, lung fungous disease and nephrotic syndrome. Sixteen of all patients were diagnosed as Cryptococcus neoformans meningitis in a week. However, 18 cases （52.9%） were misdiagnosed as tuber-culous meningitis, virus meningitis and purulent meningitis. All patients in our study were mainly given only amphotericin B （AMB） or AMB combined with fluconazole. [Conclusion] Cryptococcus neoformans meningitis is easily misdiagnosed because its clinical manifestations are no obviously specific in early stage. Therefore it is necessary to be cautious for CNM. The detection of cerebrospinal fluid for many times is the key to prevent misdiagnosis. AMB combined with fluconazole is considered as a principal therapeutic regimen.

关 键 词：脑膜炎 隐球菌性 

分 类 号：R515.2[医药卫生—内科学]