脑脊液检测对隐球菌性脑膜炎的临床意义

The clinical significance of the cerebrospinal fluid examination in cryptococcal meningitis

目的探讨脑脊液(CSF)检测对隐球菌性脑膜炎(CM)的临床诊断、治疗及预后的意义。方法分析36例CM患者的CSF动态变化、疗效及转归。结果 CM患者在治疗前32例(88.9%)CSF压力升高、34例(94.4%)墨汁染色阳性、26例(72.2%)白细胞总数升高、33例(91.7%)蛋白质含量升高、27例(75.0%)氯化物含量降低,治疗后6例(33.3%)脑脊液压力升高、4例(22.2%)墨汁染色阳性、8例(44.4%)白细胞总数升高、10例(55.6%)蛋白质含量升高、4例(22.2%)氯化物含量降低,且上述指标均呈动态变化。36例患者中治愈17例(47.2%),好转10例(27.8%),死亡9例(死于脑疝)(25%)。结论脑脊液检查是CM临床诊断最重要的手段,在治疗过程中可作为动态观察CM疗效的指标。

Objective To investigate the significance of cerebrospinal fluid（CSF）examination for clinical diagnosis,treatment and prognosis in cryptococcal meningitis.Methods Analyze the dynamic changes of cerebrospinal fluid（CSF）of 36 patients with cryptococcal meningitis and observe the therapeutic effect and turnover.Results Before the treatment,CSF pressure increased in 32 patients（88.9%）,India ink capsule staining was positive in 34 patients（94.4%）,total leucocytes increased in 26 patients（72.2%）,protein content increased in 33 patients（91.7%）,chloride content decreased in 27 patients（75.0%）.After the treatment,CSF pressure increased in 6 patients（33.3%）,India ink capsule staining was positive in 4 patients（22.2%）,total leucocytes increased in 8 patients（44.4%）,protein content increased in 10 patients（55.6%）,chloride content decreased in 4 patients（22.2%）.These indexes changes in CSF were dynamic during the treatment.In the 36 patients,17 patients were cured（47.2%）,10 patients were improved（27.8%）and 9 patients were dead（by cerebral hernia）（25.0%）.Conclusion The examination of CSF is the most important method and can be regarded as one for judging therapeutic effect dynamicly with cryptococcal meningitis.