非AIDS相关新型隐球菌性脑膜脑炎的临床及头颅磁共振成像特点  

Clinical and MRI characteristics of cryptococcal meningoencephalitis in HIV-negative patients

作　　者：李敏[1] 刘佳[1] 易寰 徐莉[1] 彭福华[1] 

机构地区：[1]中山大学附属第三医院神经内科,广州510630

出　　处：《新医学》2017年第3期169-172,共4页Journal of New Medicine

基　　金：广东省自然科学基金(2015A030313167);广州市科技计划项目(1563000227);国家自然科学基金(81271327)

摘　　要：目的探讨非AIDS相关新型隐球菌性脑膜脑炎(CM)的临床及头颅MRI特点。方法收集确诊为非AIDS相关新型CM的126例患者的既往病史、家禽接触史、临床资料、脑脊液及头颅MRI结果,按是否有可明确影响免疫功能的基础病分为无易感因素组和有易感因素组,并进行回顾性分析。结果新型CM主要表现为发热、头痛、恶心、呕吐,脑膜刺激征阳性,脑脊液压力和白细胞数升高,脑脊液糖降低。无易感因素组71例(56.3%),有易感因素组55例(43.7%),乙型病毒性肝炎(28例,50.9%)为主要易感因素。无易感因素组的家禽接触史为19.7%,高于有易感因素组的4.0%(P<0.05),有易感因素组脑膜刺激征阳性率56.4%和脑脊液糖2.1 mmol/L(中位数),高于无易感因素组的43.7%和1.61 mmol/L(P均<0.05),2组在头颅MRI表现脑膜强化及累及脑实质病变方面比较差异无统计学意义。结论新型CM确诊依靠病原学诊断,主要表现为脑膜刺激征和颅内压升高,在头颅MRI主要表现为脑膜强化及累及脑实质病变,具有一定特点,对该病的早期诊断及鉴别诊断有重要意义。Objective To explore the clinical and head magnetic resonance imaging（MRI） characteristics of HIV-negative patients diagnosed with cryptococcal meningoencephalitis（CM）.Methods Medical history,poultry exposure,clinical data,cerebrospinal fluid and head MRI findings of 126 non-AIDS CM patients were collected.Based on the primary diseases,all patients were divided into two groups with or without predisposing factors and retrospectively analyzed.Results The main manifestations of CM were fever,headache,nausea,vomiting,and positive meningeal irritation,with increasing cerebrospinal fluid pressure and white blood cell count,and decreasing cerebrospinal fluid glucose.The majority of patients were apparently healthy（71 patient,56.3%） and predisposing factors were idenfied in only 51（43.7%） patients,with hepatitis B accounting for the most common underlying factor in these cases（28 patents,50.9%）.Poultry exposure history rate of 19.7% in the group without prediposing factors,was significantly higher than which of 4%in the group with prediposing factors（P〈0.05）.Meningeal irritation postive rate of 56.4% and the average value of CSF glucose 2.1mmol/L in the group with predisposing factors was significantly higher than meningeal irritation postive rate of 43.7% and the average value of CSF glucose 1.61mmol/L（both P〈0.05） in the group without predisposing factors.Whereas MRI findings manifested as meningeal enhancement and cerebral parenchymal lesions did not differ between two groups.Conclusions The final diagnosis of CM depends on pathological examination.CM mainly manifested as meningeal irritation and intracranial hypertension in clinical,and meningeal enhancement and cerebral parenchymal lesions in MRI findings,with certain characters,which is important for early diagnosis and differential diagnosis of CM.

关 键 词：新型隐球菌脑膜脑炎 临床表现 磁共振成像 

分 类 号：R519.4[医药卫生—内科学]