某医院住院结核性和隐球菌性脑膜炎的临床特征比较

Differential Diagnosis in Patients with Tuberculous Meningitis and Cryptococcus Meningitis

目的探讨结核性脑膜炎(结脑)和隐球菌性脑膜炎(隐脑)的临床和脑脊液鉴别要点。方法回顾性调查并比较1993年2月～2003年12月收治的42例结脑和39例隐脑患者的临床表现和特效治疗前的脑脊液结果。结果4.8%的结脑和51.3%的隐脑以头痛为首发症状,结脑和隐脑发生视力改变、听力下降、肢体瘫痪的比例分别为9.5%和56.4%、0和12.8%、21.4%和0;视神经乳头水肿的发生率分别为14.3%和69.2%,且隐脑患者多为中、重度水肿。7.1%的结脑和94.9%的隐脑患者脑脊液压力大于400mmH2O。43.6%的隐脑患者脑脊液中蛋白质含量正常,有升高者大部分为轻度升高,大于2g/L者仅占7.7%。而结脑均有蛋白质含量升高,且52.4%的患者大于2g/L。结论患者具有下列特征时考虑隐脑可能性大:起病时以头痛为主而不伴发热,听力损害出现早,中、重度视神经乳头水肿,脑脊液压力显著升高,蛋白质正常。而感染中毒症状突出,脑脊液中蛋白质含量明显升高,特别是大于2g/L时,结脑的可能性较大。

Objective To search for the main differentia culous meningitis（TBM） and cryptococcus meningitis（CCM）. points in clinical and CSF changes between patients with tuber- Methods Forty - two cases of TBM and 39 cases of CCM who admitted to hospital from February 1993 to December 2003 were investigated retrospectively. Main symptoms, signs and OSF changes before administration of specific antibiotics were compared. Results 4.8 % （2/42） TBM and 51.3 % （22/39） CCM patients had headache without fever at the onset. The incidences of symptoms of failing eyesight, hearing loss and paralysis of extremities were 9.5% （4/42） and 56.4% （22/39） ,0 and 12.8% （5/39） ,and 21.4% （9/42）and 0 in TBM and CCM patients respectively.The rate and the degrees of papilledema in OCM patients（69.2% ,27/39 slight, 11/27 moderate,and 3/27 serious） were significantly higher and more serious than that in TBM patients （ 14.3%, 5/6 slight）. The patients with initial CSF pressure over 400 mmH2O were 7.1% and 94.9% in TBM and CCM. All but 43.6% CCM patients had elevation of CSF protein content, and 52.4 % （22/42） TBM and 7.7 % （3/39） CCM were 2g/L. Conclusions The most important differences between TBM and CCM are. headache not accompanied by fever at the onset, failing eyesight, striking elevation of initial CSF pressure, moderate and serious degree of papilledema, normal CSF protein content occurs usually in CCM more than those in TBM patients. On the other hand, striking elevation of CSF protein content（〉2g/L） occurs usually in TBM patients.