30例HIV阴性患者隐球菌性脑膜炎的临床分析  

Clinical analysis of 30 patient with cryptococcal meningitis and without human immunodeficiency virus infection

作　　者：陈中举[1] 田磊[1] 朱旭慧[1] 闫少珍[1] 汪玥[1] 孙自镛[1] 管青[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院检验科,湖北武汉430030

出　　处：《中国实验诊断学》2017年第1期1-4,共4页Chinese Journal of Laboratory Diagnosis

基　　金：国家"十三五"科技重大专项子课题(2016ZXl0004207-004)

摘　　要：目的探讨非HIV感染患者隐球菌性脑膜炎的临床特征,以提高该病的诊治水平。方法回顾性分析同济医院收治的30例诊断为隐球菌性脑膜炎患者的临床资料。结果 30例患者均有头痛症状(100%),22例患者有发热症状(73.3%);脑脊液葡萄糖(1.827±1.042 mmol/L)降低尤为显著;脑脊液IgG(128.51±62.42 mg/L)、IgA(15.17±11.51mg/L)和IgM(7.56±10.12mg/L)升高明显。所有患者均有不同程度的颅内压增高表现。脑脊液涂片墨汁染色阳性24例(80%),脑脊液培养出新型隐球菌23例(76.7%),隐球菌荚膜多糖抗原检测阳性者30例(100%)。培养出的隐球菌对两性霉素B、5-氟胞嘧啶和氟康唑的敏感率分别为95.6%、91.3%和100%。20例患者首诊使用两性霉素B联合5-氟胞嘧啶治疗,症状均有不同程度缓解。结论隐球菌性脑膜炎早期诊断和早期治疗很重要;新型隐球菌对两性霉素B及三唑类抗真菌药的敏感性较高,两性霉素B联合5-氟胞嘧啶仍是治疗隐球菌感染的首选方案,早期控制感染及降低颅内高压是治疗的关键。Objective To investigate the clinical features of cryptococcal meningitis without human immunodeficiency virus infection,and to improve its diagnosis and treatment.Methods The clinical data of 30 cases with cryptococcal meningitis in Tongji Hospital were analyzed retrospectively.Results All cases had headache symptoms（100%）,and22 patients had fever（73.3%）.CSF glucose（1.827±1.042mmol/L）reduced significantly;CSF IgG（128.51±62.42mg/L）、IgA（15.17±11.51mg/L）and IgM（7.56±10.12mg/L）increased significantly.All patients had increased intracranial pressure for certain degrees.The positive rate of cerebrospinal fluid ink staining accounted for 80%（24cases）,the rate of cryptococcal culture positive accounted for 76.7%（23cases）,while capsular polysaccharide antigen detection was 100% positive;The sensitive rate of amphotericin B,5-fluorocytosine and fluconazole to cultured cryptococcus are 95.6%,91.3%and 100%.The combined treatment of amphotericin B and 5-fluorocytosine were used for 20 cases,the symptoms of these patients have varying degrees of relief.Conclusion Diagnosis and treatment early of cryptococcal meningitis is very important.Cryptococcus neoformans has higher sensitivity to amphotericin B and triazole antifungal drug.The combination of AmpB and 5-fluorocytosine is still the first antifungal treatment options.Effective control of infection and decreasing intracranial hypertension is crucial to treatment.

关 键 词：隐球菌性脑膜炎 新型隐球菌 诊断 治疗 

分 类 号：R519.4[医药卫生—内科学] R446.1[医药卫生—临床医学] R512.91