61例新型隐球菌性脑膜炎临床和病理分析  

Analysis of clinical and pathological characteristics in 61patients with cryptococcus neoformans meningitis.

作　　者：利玉欢 李玲[2] 黄如训[2] 鹿寒冰[3] 王艺东[2] 李阳[4] 

机构地区：[1]广东南海市人民医院内科,528200 [2]中山大学附属第一医院神经科,510080 [3]江苏徐州市第四人民医院,225000 [4]中山大学中山医学院病理教研室,510089

出　　处：《新医学》2002年第10期589-591,共3页Journal of New Medicine

摘　　要：目的:总结新型隐球菌性脑膜炎的临床和病理学特点。方法:回顾性分析61例经病原学或尸体解剖病理证实的新型隐球菌性脑膜炎的临床和病理学资料。结果:新型隐球菌性脑膜炎的临床表现以颅内高压、脑膜刺激征为主,可有中枢神经系统局灶损害症状,脑脊液压力升高53例,其中超过2.94kPa(30cmH2O)42例。尸体解剖发现脑膜渗出、增厚及肉芽肿病变,以脑室脉络丛为甚。结论:新型隐球菌性脑膜炎的主要临床表现是进行性颅内压升高。对进行性颅内压升高、脑膜刺激征阳性的患者反复进行脑脊液墨汁染色查新型隐球菌,有助于减少新型隐球菌性脑膜炎的误诊和漏诊。Objective :To investigate the characteristics of clinical manifestation and pathology in patients with cryptococcus neoformans meningitis.Methods :Clinical manifestati on and patholo gical characteristics of cryptococ cus neoformans meningitis were analyzed retrospectively in 61patients with established diagnosis by e tiolog ical examination and autospy.Results:The main clinical manifestations were int racranial hypertension and signs of meningeal i rritation syndrome.Focal neurol ogical signs might be found.The intracranial pressure increased in53cases.4 2cases had intracranial p ressure higher than 2.94kPa(30cmH 2 O).Exudation and granuloma were found in meninges particularly in ventricu lar choriod pl exus.Conclusion:The clinical manifestations of cryp tococcus ne oforman meningitis are mainly pro gressive intracranial hypertensio n.When prog ressive intracranial hypertension and meningeal irri-tation syndrome occur ,ce rebral spinal fluid should be exam ined repeatedly by india ink stainin g,in or der to prevent misdiagnosis and missed-diagnosis. Key words: Cryptococcus ne oformans Meningiti s Clinical manifestation Pathology Misdiagnosis ne with am monium persulfate digestion that was modified and being applied by the laborator y of CDC,USA.Methods Methodological assessment and comparisons of this method wi th the national standard-chloric acid method were conducted in our lab.Results The results showed:(1)satisfied detection range of 0 to 300 ìg/L and the lowest detected limit of 4.4 ìg/L;(2)higher precision and accuracy with coefficients of variation(CV) less than 5%,and a mean recovery more than 98%in testing urin e samples with different levels of iodine;(3)lower bias of less than 5%in testi ng national standard material of urine iodine;(4)significant correlation and con sistency between two methods.Conclusions We prefer to recommend this method as a sensitive,accurate and easier to be performed method for measuring iodine in ur ine.

关 键 词：新型隐球菌性脑膜炎 新型隐球菌 临床表现 病理学 误诊 症状 

分 类 号：R519[医药卫生—内科学]