系统性红斑狼疮并发隐球菌性脑膜炎的临床特征及诊治分析  

Concurrent Presentation of Cryptococcal Meningitis and Systemic Lupus Erythematosus

作　　者：陈丽文[1] 刘肇绩[1] 郑维红[1] 陈星宇[1] 庄晓荣[1] 

机构地区：[1]厦门大学附属中山医院神经内科,福建省厦门市361004

出　　处：《中国全科医学》2013年第32期3843-3845,共3页Chinese General Practice

摘　　要：目的 总结系统性红斑狼疮（SLE）并发隐球菌性脑膜炎的临床特征,提高临床诊治水平.方法 回顾性分析我院2007年8月-2012年12月收治的5例SLE并发隐球菌性脑膜炎患者的临床资料,总结其临床表现、实验室检查结果、治疗及转归情况,并复习相关文献.结果 本组5例患者隐球菌性脑膜炎的发病年龄平均为31.0岁,病例3为活动性SLE;均有肾上腺糖皮质激素治疗史,泼尼松平均用量为21.7 mg/d.5例患者均有头痛症状,3例出现颈抵抗,2例出现视盘水肿,2例出现视物下降,2例出现发热,1例出现精神异常.5例患者脑脊液检查结果均提示炎性反应,颅内压均≥300 mm H2O,脑脊液糖含量为0.21～3.19 mmol/L,脑脊液糖含量与血糖比值为0.04～0.35,隐球菌涂片和培养均为阳性.5例患者在确诊隐球菌性脑膜炎后均给予经典方案两性霉素B联合5-氟胞嘧啶治疗,两性霉素B加量过程中联合氟康唑0.2 g/d静脉滴注.4例患者好转,1例患者出现肾功能进行性损害;2例患者常规脱水药治疗颅内高压症状改善不理想,其中1例因拒绝行脑室外引流而遗留双眼视力下降,1例行Ommaya囊脑室外引流效果不佳而自动出院.结论 SLE患者出现头痛等不典型症状时需高度怀疑隐球菌性脑膜炎,反复进行脑脊液墨汁染色,或结合动态血清隐球菌抗原监测、真菌培养,及时诊断隐球菌性脑膜炎并进行抗真菌治疗有利于改善SLE并发隐球菌性脑膜炎患者的预后.Objective To describe the clinical features of patients with systemic lupus erythematosus （SLE） who de- veloped cryptococcal meningitis. Methods Five SLE patients with cryptococcal meningitis treated in our hospital between Au- gust 2007 and December 2012 were reported, and related literature was reviewed. Results The mean onset age of cryptococcal meningitis in SLE patients was 31.0 years. One patient had active SLE and all of them had a history of receiving glucocorticoids （median prednisone dose of 21.7mg/day） before the diagnosis of cryptococcal meningitis. Headache was observed in all 5 ca- ses, neck rigidity in 3 cases, papilloedema in 2 cases, blurred vision in 2 cases, fever in 2 cases, and mental disorders in 1 case. All patients had intracranial hypertension （ 〉1300 mm H20） and normal glucose in cerebrespinal fluid （CSF） （0. 21 ~ 3.19 mmol/L） with a reduced CSF glucose level/blood glucose ratio of 0. 04 ~ 0. 35. Cerebrospinal fluid cryptococcal culture confirmed cryptococcal meningitis in all 5 cases. All patients received anti - fungal therapy with amphotericin B and flucytosine, during the process from the initial dose to regular dose of amphotericin B, fluconazole （0. 2 g/d） was given through intravenous drip. Four patients＇ clinical condition were improved, while kidney failure happened in the other one case. In two cases, the intracranial hypertension was not controlled well, one patient resisted to undergo external ventricular drainage which resulted in vision loss in both eyes, and the other one patient was unwilling to continue treatment. Conclusion As the clinical features of SLE patients with cryptococcal meningitis are non - specific, SLE patients with headache or other non - specific symptoms should be paid more attention; And CSF India ink stain, latex cryptococcal antigen agglutination test and fungus cultures should be per- formed for early diagnosis. Timely diagnosis and antifungal therapy could improve the prognosis of cryptococcal meningitis in SLE patients.

关 键 词：红斑狼疮 系统性 脑膜炎 隐球菌性 疾病特征 

分 类 号：R593.241[医药卫生—内科学] R74[医药卫生—临床医学]