新型隐球菌脑膜炎37例临床分析

目的了解新型隐球菌脑膜炎的临床特点、治疗以及预后。方法对中国医科大学附属第一医院1990～2006年期间诊断明确的37例新型隐球菌脑膜炎的患者进行回顾性分析。结果37例CNM患者均经过病原学确诊，CNM临床表现无特异性。误诊率高，首诊误诊率高达62％。大部分患者以发热、头痛、呕吐、颈强直为主要临床表现，腰穿压力高，脑脊液墨汁染色或培养可以查到新型隐球菌。37例患者中放弃治疗离院7例，治愈5例，病情好转去外院治疗者19例，病情无变化者2例，病情恶化者2例，死亡2例。两性霉素B为主要治疗药物。结论CNM大多数以亚急性或慢性起病，临床表现，脑脊液常规，生化检查以及影像学检查均缺乏特异性，所以，CNM早期易误诊，应提高对本病的警惕性，及时脑脊液涂片查病原体有利于确诊，脑脊液或脑组织病原学检查发现隐球菌是诊断的金标准，多种快速检测手段相结合可提高早期诊断率。

Objective To study clinical features, treatment methods and prognosis of cryptococcal neoformans meningitis（CNM）, Methods The clinical data of 37 cases with CNM were analyzed retrospectively from 1990-2006 year in department of neurology, the first affiliated hospital, Results All patients were identified by pathogen, Clinical presentations of CNM were not special, so it is easily misdiagnosised, Misdiagnosis rate was 62% at first time to consult at a doctor, The main clinical presentations of CNM are fever, headache and vomiting ,The pressure of cerebrospinal fluid（CSF） is higher than ordinary The ink stain and culture of CSF can find out cryptococcus. Through the 37 cases, 7 cases give up treatment; 5 cases are cured; 19 cases are turned for the better; 2 cases are invariable; 2 case are worsen; 2 cases are died; AmB is the main effective drug, Conclusion Most patients of CNM should be chronic or subchronic in onset,and their clinical features cerebrospinal fluid routine and biochemical test, or CT and MRI are lack of specificity, so the misdiagonosis rate were very high, Messures are necessary to prevent misdiagonosis are as follows： Raise vigilance on CNM and do CSF ink stain for crypotococcu in time, The finding of cryptococcus in CSF culture and brain biopsy should be the gold standard of diagnosis, Rapid method should be united to improve early diagnosis.