新型隐球菌脑膜炎21例临床分析  

Clinical analysis of 21 patients with cryptococcus neoformans meningitis

作　　者：兰俊[1] 黄桂梅[1] 高冉[2] 

机构地区：[1]湖北十堰市红十字医院神经内科,十堰442011 [2]首都医科大学宣武医院,北京100000

出　　处：《中国实用神经疾病杂志》2013年第24期28-29,共2页Chinese Journal of Practical Nervous Diseases

摘　　要：目的分析新型隐球菌脑膜炎(CNM)的临床特点、诊断、治疗和转归。方法对21例CNM患者的临床资料进行回顾性分析并文献复习。结果 21例患者均有脑膜刺激症状,部分有脑实质损害表现,均经病原学确诊。17例留院治疗,两性霉素B(或脂质体)联合氟胞嘧啶(5-Fu)治疗12例,AmB(或脂质体)联合氟康唑(FCZ)治疗5例。除药物降颅压外,脑室外引流术5例,侧脑室腹腔分流术2例。随访观察治愈10例,死亡7例,治愈率58.8%。结论 CNM误诊率高,早期确诊,联合用药治疗效果较好。对颅压显著增高者行脑室引流术能较快缓解症状、缩短疗程,改善预后。Objective To analyze the clinical characteristic ,dignosis,therapy and prognosis of Cryptococcus neoformans meningitis（CNM）. Methods The clinical data of 21 patients with cryptococcus meningitis were retrospectively analyzed and the medical literature was reviewed. Results All patients had meningeal irritation symptoms, part of them with signs of parenchy- real damage,and all cases were identified by laborato@ test result. 17 cases were admitted to hospital for treatment, 12 caeses received amphotericin B combined with 5 fluoroeytosine（5-FU） therapy, and 5 cases received amphotericin B combined with flu-conazole therapy. In addition to the drugs to reduce intracranial pressure , 5 cases received ventriculostomy and Lateral ventri- cle peritoneal shunt were done in 2 cases. Follow-up observation showed that 10 of the 21 cases were cured, 7 cases died ,and the cure rate is 58.8%. Conclusion misdiagnosis rate of CNM is high, early diagnosis, and the effect of combination therapy is great. Ventriculostomy for patients with increased intracranial pressure could quickly relieve symptoms , shorten period of treatment and ameliorate prognosis.

关 键 词：隐球菌脑膜炎 两性霉素B 氟胞嘧啶 氧康唑 

分 类 号：R519.4[医药卫生—内科学]