新生隐球菌性脑膜炎22例临床及预后分析  

Analysis of prognosis and clinical characteristics in 22 patients with Cryptococcus neoformans meningitis

作　　者：蔡仁慧[1] 王英[2] 

机构地区：[1]福建医科大学省立临床医学院福建省立医院皮肤科,福州350000 [2]上海长海医院皮肤科,上海200433

出　　处：《中国真菌学杂志》2017年第4期216-220,共5页Chinese Journal of Mycology

摘　　要：目的分析新生隐球菌性脑膜炎的临床特点、治疗及预后。方法回顾性分析22例患者的临床资料。结果合并基础疾病者17例(77.27%),误诊12例(54.55%)。隐脑以颅高压、脑脊液低糖高蛋白为主。22例患者均经病原学确诊。先用两性霉素B(AmB)或脂质体+5-氟胞嘧啶(5-FC)治疗者18例,待患者症状好转、脑脊液真菌转阴后,改用口服或静滴氟康唑(FCZ)巩固维持治疗,1例脑室扩大行侧脑室外引流术,2例因颅高压行Ommaya囊植入治疗。随访观察治愈6例,好转8例,死亡5例。结论 AmB+5-FC+FCZ联合治疗效果好。Objective To analyze the clinical characteristics,treatments and prognosis of Cryptococcus neoforrnans meningitis.Methods Retrospectively analyzed the clinical data of 22 patients with cryptococcal meningitis.Results There were 17 patients with underlying diseases.The nonspecific clinical and laboratory findings led to misdiagnosis of 12 patients.The main clinical manifestations were intracranial hypertention and low glucose, high protein in the cerebral fluid. The diagnosis were established in 22 patients by the present of Cryptococcus.18 patients were given amphotericin B combination with 5-FC.After their condition improved and cerebral fluid pathogeny test became negative,oral or intravenous FCN were given for maintain therapy.Paraventriculostomy was performed in 1 patient with enlarged ventricle. Ommaya reservoir were given in 2 patients with intracranial hypertension.The outcome of the 22 cases showed that 6 patient were cured,8 improved and 5 died.Conclusions Combination of antifungal therapy could achieve better effect in treatment of Cryptococcus neoformans meningitis.

关 键 词：脑膜炎 新生隐球菌 误诊 治疗 预后 

分 类 号：R519.4[医药卫生—内科学]