肉芽肿性阿米巴脑炎的临床病理学研究  

A clinicopathological study of granulomatous amoebic encephalitis

作　　者：卢德宏[1,2] 骆利康[1,2] 徐庆中[1,2] 李存江 

机构地区：[1]首都医科大学宣武医院病理科 [2]浙江衢州市人民医院

出　　处：《中华病理学杂志》1999年第3期169-173,共5页Chinese Journal of Pathology

摘　　要：目的探讨棘阿米巴属自由生活阿米巴引起的肉芽肿性脑膜脑炎的临床病理特点及鉴别诊断。方法分析３例肉芽肿性阿米巴脑炎的临床特点，ＣＴ所见和病理改变。结果肉芽肿性阿米巴脑炎是一个慢性的临床过程，其临床特点是常出现头痛，轻度发热，癫痫发作，偏瘫和昏迷。腰穿脑脊液（ＣＳＦ）压力轻度增高，ＣＳＦ中可见淋巴细胞和中性白细胞，糖的含量低，蛋白中度增高。ＣＴ扫描没有特异性改变。肉芽肿性阿米巴脑炎的临床症状和体征主要表现为伴有脑膜刺激症状的局限性脑病，临床上容易与化脓性脑膜炎或结核性脑膜炎相混淆。病理学检查发现，这种自由生活阿米巴可造成慢性或亚急性肉芽肿性脑膜脑炎。脑组织中常见灶状的出血坏死，在出血坏死的区域内可见到棘阿米巴滋养体和包囊。有的病例可见显著的血管炎，病变血管壁可见纤维素样坏死，血管周围可见淋巴细胞和浆细胞呈套袖样浸润及棘阿米巴滋养体和包囊。结论棘阿米巴是一种机会性致病的自由生活阿米巴，可引起人的致死性肉芽肿性脑炎。Objective To study the clinicopathological characteristics and differencial diagnosis of granulomatous meningioencephalitis caused by acanthamoeba. Methods The clinical features, CT scan findings and post mortem pathological changes of 3 patients afflicted with granulomatous amoebic encephalitis (GAE) were analysed. Results GAE is a chronic clinical entity. Clinical manifestations include headache, low fever, seizures, hemiparesis and coma leading to death. CSF: pressure slightly elevated with presence of lymphocytes and plasma cells, glucose usually low with moderately high protein levels. CT scans were non specific. Clinical course insidious and may mimic bacterial meningitis or tuberculous meningitis. Post mortem pathological examinations showed that acanthamoeba produced a chronic or subacute granulomatous meningioencephalitis. Acanthamoebic trophoziotes and cysts were found within the hemorrhagic necrotic cerebral tissues. In some cases there is severe angitis and fibrinoid necrosis of the vascular wall with perivascular cuffing by lymphocytes and plasma cells. Trophozoites and cysts were found within the perivascular space. Conclusions Acanthamoeba is an opportunistic pathogenic free living amoeba which can produce fatal GAE.

关 键 词：阿米巴病 棘阿米巴属 病理学 尸体解剖 

分 类 号：R531.102[医药卫生—内科学]