新型隐球菌性脑膜炎26例临床观察  

Clinical analysis of 26 cases with cryptococcal meningitis

作　　者：胡微微[1] 赵玉武[1] 潘庆春[1] 奚敏[1] 汤正好[1] 臧国庆[1] 

机构地区：[1]上海交通大学附属第六人民医院感染科,200233

出　　处：《中国现代神经疾病杂志》2014年第8期693-696,共4页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的观察新型隐球菌性脑膜炎的临床特点,总结分析其临床表现、实验室检查、鉴别诊断与治疗原则,探讨新型隐球菌性脑膜炎治疗进展。方法对26例新型隐球菌性脑膜炎患者的临床资料进行回顾,总结其治疗经验。结果所有患者均表现为头痛、发热,脑脊液乳胶凝集试验阳性,其中21例脑脊液墨汁染色可见新型隐球菌生长。经两性霉素B联合氟胞嘧啶、氟康唑治疗,总有效率达76.92%(20/26);4例早期采用两性霉素B联合伏立康唑治疗的患者症状与体征明显改善。结论新型隐球菌性脑膜炎误诊率高,脑脊液乳胶凝集试验阳性有助于早期明确诊断,可减少误诊率。两性霉素B、氟胞嘧啶、氟康唑均为一线抗真菌药物,联合用药可提高疗效。Objective To study the clinical features of cryptococcal meningitis （CM） and summarize its clinical manifestations,laboratory data,differential diagnosis and treatment,so as to discuss the treatment progress of CM.Methods Clinical data of 26 cases with CM were retrospectively analyzed,and the treatment experiences were summarized.Results All patients had headache and fever,and were positive for cerebrospinal fluid （CSF） latex agglutination test.Twenty-one patients＇ CSF smear were found Cryptococcus neoformans.Almost 76.92% （20/26） of patients were cured or became better after receiving combined treatment of amphotericin B,flucytosine and fluconazole.The symptoms and signs of 4 patients who received combined treatment of amphotericin B and voriconazole were greatly improved.Conclusions CM can prone to be misdiagnosed at early stage.CSF smear and fungi culture are beneficial to the diagnosis.Latex agglutination test is a quick and easy examination to reduce the misdiagnosis rate of CM.The combination of amphotericin B,flucytosine and fluconazole is effective for the treatment of CM.

关 键 词：脑膜炎 隐球菌性 两性霉素B 药物疗法 联合 

分 类 号：R519.4[医药卫生—内科学]