94例成年隐球菌性脑膜脑炎患者的临床特点分析  

An analysis on clinical features of 94 adult patients diagnosed with cryptococcal meningoencephalitis

作　　者：郑卉[1] 王冬梅[1] 李明月[1] 陈琼[1] 张晓梅[1] 杨曼[1] 王群[1] 

机构地区：[1]南方医科大学南方医院神经内科,广州510515

出　　处：《中华神经医学杂志》2015年第8期821-824,共4页Chinese Journal of Neuromedicine

摘　　要：目的总结成年隐球菌性脑膜脑炎患者的临床表现和治疗方法，并探讨与其生存时间相关的影响因素。方法回顾性分析南方医科大学南方医院神经内科自1998年7月1日至2013年6月30日收治的94例成年隐球菌性脑膜脑炎患者的流行病学特点、临床特点、治疗方法及预后，采用Cox回归分析影响患者生存时间的因素。结果该病好发于60岁以下中青年男性，且多以头痛（70例，74.47％）和发热（58例，61．70％）等非特异性症状起病。长期激素和（或）免疫抑制剂的应用是最常见的基础病症。颅内压增高（〉180mmH2O）者占86．17％（81例1，脑脊液蛋白升高（〉0．45g/L）者占73．40％（69例）和糖降低（≤2．25mmol／L）者占57．45％（54例）。而脑脊液糖／血糖比值降低与患者的生存时间相关（P=0．011，OR=0．119）。结论对于以头痛、发热起病，脑脊液压力明显增高伴脑脊液糖明显降低但脑电图无特异性的亚急性或慢性成年颅内感染患者．需排除隐球菌感染的可能性。治疗过程中，需要重点关注第1次腰椎穿刺脑脊液糖／血糖比值降低的患者。Objective To conclude the clinical features and treatments of adult cryptococcal meningoencephalitis （CM） patients. Methods Retrospective analysis of epidemiological characteristics, clinical features, treatments and prognoses of 94 adult CM patients, admitted to our hospital from July 1, 1998 to June 30, 2013, was performed. Cox regression analysis was performed to explore the influencing factors of survival time. Results CM was common in male adult patients who were younger than 60 years old. Nonspecific symptoms, such as headache and fever, were found most frequently. The most common risk factor was chronic usage of corticosteroid and/or immunosuppressants. The increased cerebrospinal fluid （CSF） pressure （〉180 mmH20） was noted in 81 patients （86.17%）, increased CSF protein level（〉0.45 g/L） was noted in 69 patients （73.40%） and decreased CSF glucose level （≤2.25 mmol/L） was noted in 54 patients （57.45%）. The ratio of CSF glucose/blood glucose was associated to survival time of adult CM patients （P=0.011, OR=0.119）. Conclusions CM should be considered when the adult patients have sub-acute or chronic headache and/or fever, with obviously increased CSF pressure, decreased CSF glucose level and non-specific EEG features. More attention should be called for the patients with decreased ratio of CSF glucose/blood glucose.

关 键 词：隐球菌性脑膜脑炎 脑脊液糖/血糖比值 

分 类 号：R519.4[医药卫生—内科学]