隐球菌脑膜炎42例临床分析

Clinical Analysis of 42 Patients with Cryptococcal Meningitis

目的:归纳分析42例隐球菌脑膜炎的发病情况、临床特点并总结抗真菌药物的治疗经验,以提高对隐球菌脑膜炎的诊治水平。方法:回顾分析四川大学华西医院2001～2007年所收治42例隐球菌脑膜炎病例的临床表现、实验室检查结果、抗真菌药物的疗效及预后,并对两性霉素B联合5-氟胞嘧啶抗真菌治疗的药物剂量、疗效、不良反应以及疗程与预后的关系加以剖析。结果:临床以发热、头痛、颅内压升高、脑膜刺激征为主要表现,采用两性霉素B联合5-氟胞嘧啶治疗,总有效率78.5%,42例患者治愈9例,好转24例,死亡5例,自动出院后失访4例。结论:隐球菌脑膜炎由于临床表现、脑脊液常规和生化检查以及影像学检查无明显特异性,易于误诊;脑脊液墨汁染色有助于早期诊断本病,对疑似病例反复进行脑脊液墨汁染色有利于确诊;两性霉素B联合5-氟胞嘧啶治疗治疗隐球菌脑膜炎效果良好。但需注重合理应用并密切监测不良反应。

Objective： To improve the management level of Cryptocaccal meningitis by analyzing clinical data of 42 patients. Methods： Retrospectively studied clinical manifestation, auxiliry examinations, misdiagnosis and therapy based on 42 patients with Cryptococcal meningitis in West China Hospital. Results： The main clinical manifestation included fever, headache, intracranial hypertension and signs of meningeal irritation. The total effective rate was 78. 5% by Amphotericin B monotherapy or combined with 5-fluorocytosine. In general, 9 cases were cured, 24 were improved, 5 died and 4 gave up any further treatment. Conclusion： Cryptococcal meningitis is easily misdiagnosed due to its non-specific clinical manifestations in early stage. Detection of cerebrospinal fluid is frequently crucial for preventing misdiagnosis. Combination therapy using Amphotericin B with 5-fluorocytosine is effective and well tolerable.