新型隐球菌颅内感染的临床表现及其抗原检测的临床应用

Clinical presentation and cryptococcal antigen detection in patients with CNS cryptococcus neoformans

目的探讨新型隐球菌性颅内感染的临床特点、脑脊液的相关检查和隐球菌抗原胶乳凝集系统检测的临床应用。方法应用临床病例分析统计方法,对本院78例确诊的新型隐球菌脑膜炎或脑炎患者的发病规律、临床特点和脑脊液检查进行归纳、分析,并进行脑脊液隐球菌抗原胶乳凝集系统的检测。结果78例患者中有69例(88.5%)为亚急性或慢性起病,9例(11.5%)为急性起病,64.1%以上的患者有头痛、发热;第1次腰穿隐球菌抗原胶乳凝集检查阳性者为97.4%。结论新型隐球菌颅内感染起病形式各异,临床表现、脑脊液常规、生化检查及头颅影像学检查均缺乏特异性;隐球菌抗原胶乳凝集对早期诊断新型隐球菌颅内感染有重要价值。

Objective To investigate the clinical features of the central nervous system cryptococcosis, the change of cerebrospinal fluid, and the clinical application of cryptococcal antigen detection system. Methods The clinical manifestations and the CSF change in 78 patients with CNS cryptococcus neoformans were analyzed using clinical statistical method. Each patient had the cryptococcal antigen detection with CSF sample. Results The onsets of 88. 5% （69/78） of patients were chronic or subacute. Headache and fever were the most common symptoms, which occured over 64. 1% of patients. Conclusions The onset of most patients with CNS crytococcosis was chronic or subacute, and their clinical features, cerebrospinal fluid routine, biochemical test and CT or MRI findings were not specific. The detection of cryptococcus in cerebrospinal fluid culture and brain biopsy is the golden standard of diagnosis, but the positive rate was low. It is very important for early diagnosis of the cerntral nervous system cryptococcosis to detect cryptococcal antigen by using CALAS.