新生隐球菌性脑膜炎25例临床分析  

Clinical features of 25 cases of cryptococcal meningitis

作　　者：王冯滨[1] 欧强[1] 励峰[1] 陈武[1] 

机构地区：[1]上海市公共卫生临床中心感染科二科,201508

出　　处：《中国感染与化疗杂志》2010年第1期41-43,共3页Chinese Journal of Infection and Chemotherapy

摘　　要：目的分析新生隐球菌性脑膜炎的临床特点,提高临床医师对本病的诊疗水平。方法回顾性分析我中心感染科确诊的新生隐球菌性脑膜炎25例住院患者临床资料。结果25例患者中,男17例,女8例,以青壮年居多。21例合并有基础疾病,包括艾滋病、淋巴瘤、干燥综合征、重症肌无力。所有患者均有发热、颅高压症状。17例(68%)出现意识障碍;5例(20%)出现抽搐;9例(36%)出现视力下降或视物模糊,6例(24%)出现听力下降。脑膜刺激征阳性14例(56%),病理征阳性12例(48%)。脑脊液检查提示蛋白增高,白细胞计数均在100×106/L以下,糖和氯化物降低。脑脊液压力明显增高。23例患者脑脊液涂片墨汁染色找到隐球菌。16例治愈或好转出院,死亡9例。结论隐球菌性脑膜炎是病情危重的中枢神经系统感染性疾病。脑脊液涂片墨汁染色找到隐球菌可明确诊断。早期诊断,及时抗真菌治疗是提高隐脑救治成功率的关键。Objective To analyze the clinical features of cryptococcal meningitis and improve the management of such infections.Methods The clinical data of 25 cases of cryptococcal meningitis were analyzed retrospectively.Results The analysis included 17 males and 8 females.Most patients were young adults.Underlying diseases were identified in 21 patients,including AIDS,lymphoma,Sjogren syndrome and myasthenia gravis.All patients had fever and intracranial hypertension.The symptoms included consciousness disorder（17,68%）,convulsion（5,20%）,impaired vision（9,36%） and hearing loss（6,24%）.Meningeal irritation sign was positive in 14 cases.The pathological sign was positive in 12 cases.The level of protein was high and leukocyte count was below 100×106/L in cerebrospinal fluid.Chloride and glucose were lower than normal.The pressure of cerebrospinal fluid was much higher.Cryptococcus neoformans was identified in 23 cases by China ink staining.Antifungal therapy resulted in clinical cure or improvement in 16 cases.Nine patients died.Conclusions Cryptococcal meningitis is severe infection of central nervous system.Cryptococcal meningitis can be confirmed by identifying Cryptococcus in cerebrospinal fluid.Early diagnosis and timely treatment is the key to treatment success.

关 键 词：隐球菌性脑膜炎 诊断 治疗 

分 类 号：R519[医药卫生—内科学]