隐球菌性脑膜炎患者真菌培养结果分析及潜在意义

The Analysis and potentialsignificance of cerebrospinal fluid Culture in patients with cryptococcal meningitis

目的探讨真菌培养结果对隐球菌性脑膜炎诊疗的意义。方法回顾性分析了隐球菌患者的脑脊液培养结果及印度墨汁染色结果,将两者对照研究。结果 45例隐球菌性脑膜炎患者首次脑脊液培养结果43例阳性,虽然高于印度墨汁染色38例阳性的结果,但差异无统计学意义(χ2=1.975,P=0.157);治疗中期脑脊液培养结果30例为阳性,和印度墨汁染色的结果比较未见差异(χ2=1.661,P=0.195);首次脑脊液培养结果显示26例患者对氟康唑耐药而未见对两性霉素B耐药者(χ2=33.804,P=0.000);治疗末期脑脊液培养的结果先于印度墨汁染色转阴,10例印度墨汁染色持续阳性患者,脑脊液培养转阴患者停药后未见复发[P(1≤X)=0.002]。结论脑脊液培养对指导隐球菌脑膜炎患者抗真菌药物的使用有重要的价值,需高度重视;培养结果可能更适合作为停药的指标之一。

Objective To explore the significance of CSF（cerebralspinal fluid）culture in patients with cryptococcal meningitis.Methods Analysed the cerebrospinal fluid culture results amd India ink stain results of paitients with cryptococal meningitis.Results CSF culture was positive in 43 cases among 45 patients with cryptococcal meningitis in the first time test,higher than that（38） in the India ink stain,but no statistical difference（χ 2 =1.975,P = 0.157）;CSF culture Results of 30 cases were positive after two weeks treatment,compared with the India ink staining Results showed no difference（χ 2 =1.661 2,P = 0.195） ;CSF culture showed 26 patients resistant to fluconazole and none resistant to amphotericin B（χ 2 =33.804 2,P = 0.000）;At the end of period of treatment,CSF culture Results turned to negative earlier than that in the India ink staining.10 cases of India ink stain positive patientshadnorecurrence,when withdraw antifungal drugsafter CSF culture turned to negative [P（1≤X） =0.002].Condlusion We highlight the importance of CSF cultures in guiding treatment decisions in the patients with cryptococcal meningitis.CSF culture may be more reliable as the criterion for stopping treatment.