颅内曲霉菌病临床分析  

Clinical analysis of intracranial aspergillosis

作　　者：杨柳[1] 赵莹莹[1] 脱厚珍[1] Yang Liu;Zhao Yingying;Tuo Houzhen(Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院神经内科,100050

出　　处：《北京医学》2024年第7期539-544,共6页Beijing Medical Journal

摘　　要：目的探讨颅内曲霉菌病(intracranial aspergillosis,ICA)的临床和影像学特点及其预后。方法选取2013年1月至2024年1月首都医科大学附属北京友谊医院ICA患者9例,回顾性分析患者的临床表现、实验室检查结果、影像学特征、治疗方案和临床预后等。结果9例患者中,男5例、女4例;年龄4~70岁,平均40.4岁。ICA常见的临床表现有发热、头痛、脑神经受累、神经系统缺损症状和意识障碍等。6例患者行脑脊液检查,其中3例脑脊液压力及WBC均升高。头颅影像学示常见侵袭部位为脑实质、脑血管、海绵窦、脑膜和垂体。8例患者接受了伏立康唑药物治疗,平均治疗疗程6个月。截至2024年3月的随访,共有4例患者死亡。结论ICA常伴发脑血管疾病,尤其是脑膜型病变;ICA的临床表现缺乏特异性,免疫功能正常的人群也有曲霉菌感染的风险。mNGS有助于早期ICA的诊断,早期规范应用伏立康唑等抗真菌治疗,可明显改善患者预后。Objective To explore the clinical and imaging features and prognosis of intracranial aspergillosis(ICA).Methods A total of nine patients with ICA in Beijing Friendship Hospital,Capital Medical University from January 2013 to January 2024 were selected,and the clinical manifestations,laboratory examination results,imaging features,treatment plan and clinical prognosis of were analyzed retrospectively.Results Among the nine patients,five were male and four were female,age from 4 to 70 years,with an average age of 40.4 years.The common clinical presentations of ICA were fever,headache,cranial nerve involvement,neurological deficits,and impaired consciousness.Cerebrospinal fluid examination was performed in six patients,with three showing increased cerebrospinal fluid pressure and WBC.Cranial imaging showed that the frequently involved sites were brain parenchyma,cerebrovascular,cavernous sinus,meninges,and pituitary gland.Eight patients received voriconazole treatment,with an average duration of six months.Four patients died during the follow-up until March 2024.Conclusions ICA is often accompanied by cerebrovascular diseases,especially meningeal lesions.ICA lacks specific clinical features,and population with normal immune function are also at risk of being infected with Aspergillus.mNGS is helpful for the early diagnosis of ICA,and early standardized application of voriconazole and other fungal treatments can obviously improve the prognosis of ICA patients.

关 键 词：中枢神经系统 曲霉菌 脑脊液 宏基因组二代测序 伏立康唑 

分 类 号：R519[医药卫生—内科学]