新型隐球菌脑膜脑炎的临床特点及影像学表现

Clinical features and imaging findings of patients with cryptococcal meningoencephalitis

目的：对照分析AIDS合并新型隐球菌脑膜脑炎（CM）与HIV阴性CM患者的临床特征及影像学表现.方法：回顾性分析12例HIV阳性CM患者与14例HIV阴性CM患者临床特征、治疗与转归、影像学表现之间的共同点与不同点.结果：AIDS合并CM患者中CD4＋ T淋巴细胞〈50×106/L人数多于非AIDS患者（12/12vs2/14, P〈0.01）;AIDS合并CM患者住院持续时间长于非AIDS患者（34w vs19.84w,t =2.93,P〈0.05）;脑内强化结节灶少于非AIDS患者（0/10vs4/7,P〈0.05）;局限性脑水肿也少于非AIDS患者 （0/10vs4/9,P〈0.05）.主要临床表现相似,均为头痛,发热,不同点是AIDS合并CM患者临床症状重于非AIDS患者.MRI检出VR间隙扩大（19/19vs6/13, P〈0.01）,胶样假囊等病变的敏感性高于CT,胶样假囊可呈＂肥皂泡征＂,具有特征性.结论：AIDS合并CM患者免疫力低下,住院持续时间长,临床症状重,治疗效果差,死亡率高.MRI检出CM相关病变优于CT,可作为CM早期诊断和疗效评价的一种重要手段.

Objective To control- analyze the AIDS and non-AIDS complicated with cryptococcal meningoeneephalitis（CM） in patients of clinical features and imaging findings. Methods Retrospective analyzed the common and different points between 12 eases of AIDS and 14 cases of non- AIDS complicated with CM in patients with clinical features, treatment and prognosis, imaging findings. Results The patients with Clip＋ T lymphocytes〈50/L in AIDS patients were more than that of non-AIDS （12/14vs2/14, P 〈0.01） ; The patients with AIDS complicated with CM had longer duration of hospitalization than that of non-AIDS patients （34w vslg. 84w, t = 2.93, P d0.05）, the enhanced lesions within brain of AIDS patients were less than that of non- AIDS patients （0/10vs4/7, P d0.05）, the local cerebral edema were less than non-AIDS patients （0/10vs4/9, P 〈0. 05） too. The main clinical manifestations of the two groups such as headache, fever was similar, but the clinical symptoms in AIDS patients were more serious than in non- AIDS patients. MRI was more sensitive than CT in detecting CM like Virchow--Robin space dilatation （19/19vs6/13, P 〈0. 01）, gelatinous pseudocysts. Gelatinous pseudocysts sometimes showed ＂soap bubble sign＂, which is characteristic. Conclusions Patients of AIDS complicated with CM are immunocompromised, have longer hospitalization duration, more serious clinical manifestations, worse treatment, higher dead ratio. MRI shows lesions of CM better than CT, can be used as an important means of early diagnosis and treatment evaluation of CM.