免疫功能缺陷宿主与非免疫缺陷宿主的隐球菌脑膜炎的临床特征  

Analysis of cryptococcus meningitis non-immunocompromised host and cryptococcus capsular antigen

作　　者：于丽侠[1] 李明晖[1] 阮永春[1] 周宜庆 曾敏 YU Lixia;LI Minghui;RUAN Yongchun;ZHOU Yiqing;ZENG Min(Department of Infectious Diseases,Shaoxing People′s Hospital in Zhejiang Province,Shaoxing 312000,China)

机构地区：[1]浙江省绍兴市人民医院感染科,浙江绍兴312000

出　　处：《中国现代医生》2021年第2期12-17,共6页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2019KY716)。

摘　　要：目的分析免疫缺陷宿主合并隐球菌脑膜炎(CM)的临床特征,以期提高临床医师对本病的诊治水平。方法回顾性分析2005年1月至2018年6月我院收治的78例隐球菌脑膜炎患者,依据患者是否存在免疫缺陷分为免疫缺陷宿主合并隐球菌脑膜炎组(ICH-CM组)和非免疫缺陷宿主合并隐球菌脑膜炎组(NON-ICH-CM组),主要观察两组患者的临床表现、影像学改变、脑脊液隐球菌荚膜抗原的差异,并观察血液和脑脊液隐球菌荚膜抗原滴度对隐球菌脑膜炎的评估价值。其中ICH-CM组患者61例,NON-ICH-CM组17例,记录两组患者的基础疾病及激素、免疫抑制剂使用情况和既往或同时存在颅内病变的情况。结果ICH组与NON-ICH组在临床表现上比较,差异无统计学意义(P>0.05),影像学缺乏典型的表现,两组均可表现为脑膜强化、脑梗死、多发缺血灶,但差异无统计学意义(P>0.05),且脑脊液的隐球菌荚膜抗原滴度为(977.06±799.12),高于血的(498.13±463.71),差异有统计学意义(P<0.05)。ICH-CM组死亡20例(32.78%),NON-ICH-CM组死亡1例(5.88%),两组患者的死亡率比较,差异无统计学意义(P>0.05)。结论免疫受损宿主容易合并各种感染,其中隐球菌性脑膜炎发病较隐匿,缺乏特征性,尤其是长期接受激素或免疫抑制剂的患者,早期诊断、及时治疗对预后影响很大。Objective To analyze the clinical features of immunodeficiency host with cryptoococcal meningitis(CM)in order to improve clinicians′diagnosis and treatment of this disease.Methods A total of 78 patients with cryptococcal meningitis treated in our hospital from January 2005 to June 2018 were retrospectively analyzed.They were divided into immunocompromised host(ICH)and non-immunocompromised host(NON-ICH),depending on whether the patient had an immune deficiency.The differences in clinical manifestations,imaging changes,and cerebrospinal fluid cryptococcal capsular antigen between the two groups were observed.And the value of blood and cerebrospinal fluid cryptococcus capsular antigen titers in the evaluation of cryptococcal meningitis was observed.Among them,there were 61 ICH patients and 17 NON-ICH patients.The underlying diseases,hormones,immunosuppressive agents,and previous or concurrent intracranial lesions were recorded.Results There were no significant differences in clinical manifestations between the ICH-CM group and the NON-ICH-CM group(P>0.05),and the imaging lacked typical manifestations.Both groups showed meningeal enhancement,cerebral infarction,and ischemic changes,but there were no statistically significant differences between two groups(P>0.05).And the CSF cryptococcus capsular antigen titer(977.06±799.12)was higher than blood cryptococcus capsular antigen titer(498.13±463.71),with significant difference(P<0.05).Twenty patients died in the ICH-CM group(32.78%),and one patient died in the NON-ICH-CM group(5.88%).The mortality rate was high in the two groups,with no significant difference(P>0.05).Conclusion Immunocompromised hosts are susceptible to various infections.Among them,cryptococcal meningitis has relatively insidious disease and lacks characteristics.Especially for patients who have been receiving hormones or immunosuppressants for a long time,early diagnosis and timely treatment have a great impact on the prognosis.

关 键 词：隐球菌性脑膜炎 免疫受损宿主 非免疫缺陷宿主 隐球菌荚膜抗原 

分 类 号：R379.5[医药卫生—病原生物学]