新型隱球菌性腦膜炎38例臨床特征及療效觀察

馮潤川 李 莎 宋曉玲

[摘要] 目的 總結38例新型隱球菌性腦膜炎的臨床特征及療效。方法 回顧性分析38例新型隱球菌性腦膜炎臨床資料。結果 新型隱球菌性腦膜炎診斷根據病史、臨床特征和特異性輔助檢查指標;臨床常誤診;以中、重型為主(76.3%),合并癥多,預后不良,病死率高。少數輕型(23.7%),易耐受規則、足量、足療程抗真菌治療,預后良好。治療以抗真菌、降顱壓為主,應注重綜合治療。 結論 新型隱球菌性腦膜炎應結合流行病學史,頭暈、頭痛、嘔吐、發熱等臨床癥狀和腦脊液檢查等客觀指標,并注意排除其他顱內感染或病變作出診斷;治療宜個體化抗真菌,強化降顱壓,營養支持,保護心、肝、腎等重要器官和預防并發癥治療。

[關鍵詞] 新型隱球菌;新型隱球菌性腦膜炎;臨床特征

[中圖分類號] R551[文獻標識碼] A[文章編號] 1004-8650(2009)06-07-04

Observation clinical feature and curative effect of 38 patients with Cryptococcal meningitis

FENG Run-chuan,LI Sha,SONG Xiao-ling

(The first of Medical Department,Fourth People's Hospital of Nanning,Nanning 530023,China)

[Abstract] Objective To summarize the clinical features and efficacy of 38 patients with Cryptococcal meningitis.Methods To retrospective analysis clinical data in 38 patients with Cryptococcal meningitis.Results It is based on history, clinical features and examination of specific indicators to diagnose Cryptococcal meningitis;Clinical often misdiagnosed;The majority of patients of Cryptococcal meningitis are medium and heavy-oriented cases (29/38, accounting for 76.3%),the rapid course of disease,complications ,and poor prognosis,high mortality. a small number of them are light cases (9/38,accounting for 23.7%),easy-tolerance rules, in sufficient quantities, adequate treatment of anti-fungal treatment, prognosis is good.we should be focus on comprehensive treatment that include Anti-fungal treatment, to reduce intracranial pressure-oriented,Symptomatic and supportive care body et cetera. Conclusion Crytoccal meningitis should be combined with epidemiological history,dizziness,headache,vomiting,fever and other clinical symptoms and objective indicators such as cerebrospinal fluid examination,and pay attention to the exclusion of other intracranial infection or disease on pars encephalica;treatment should be individualized anti-fungal,strengthen the lower intracranial pressure,nutrition support,the protection of the heart,liver,kidney and other vital organs and treatment to prevent complications.

[Key words]cryptococcus neoformans;cryptococcal meningitis;clinical feature

新型隱球菌性腦膜炎(cryptococcus neoformans meningitis,CNM)是由隱球菌直接侵犯中樞神經系統引起的顱內感染,是危及人類健康的中樞神經系統疾病。由于其癥狀的不典型性及治療的不規范,誤診率及病死率仍較高。近年來隨著廣譜抗生素、激素、免疫抑制藥的廣泛或不適當應用,以及免疫缺陷性疾病及器官移植患者的增加,實驗室檢測水平的提高,該病罹患率亦呈增長趨勢?，F就我院2000年12月-2008年8月收治的經病原學確診的38例新型隱球菌性腦膜炎患者的臨床資料作一總結,探討新型隱球菌腦膜炎臨床特征及療效。

1資料與方法

1.1一般資料

2000年12月-2008年8月我院綜合感染病內科收治的38例新型隱球菌性腦膜炎患者,按2004年實用傳染病學第三版新型隱球菌性腦膜炎診斷標準[1]確診。……