隐球菌性脑膜炎与结核性脑膜炎的鉴别诊断

Study on the differential diagnosis of cryptococcal meningitis and tuberculous meningitis

目的探讨新型隐球菌性脑膜炎与结核性脑膜炎的鉴别要点。方法回顾分析13例隐球菌性脑膜炎及30例结核性脑膜炎患者的临床表现、脑脊液改变和头颅CT或MRI特点。结果隐脑颅内压(360.0±51.7)mmH2O,脑脊液葡萄糖含量(1.3±0.9)mmol/L,PCR-TB阳性率0%,抗结核抗体阳性率15.3%,与结脑颅内压(259.5±91.6)mmH2O,脑脊液葡萄糖含量(2.1±0.9)mmol/L,PCR-TB阳性率56.6%,抗结核抗体阳性率53.3%对比差异有统计学意义。而两者在临床症状、脑脊液白细胞数、蛋白、氯化物和头颅CT或MRI表现等方面差异无统计学意义。结论隐球菌性脑膜炎临床表现不典型,与结核性脑膜炎不易鉴别,容易误诊。提高对隐球菌性脑膜炎的认识,并行多项指标检测有利于早期诊断。

Objective To study on the differential diagnosis of cryptococcal Neoformans meningitis and tubercu lous meningitis. Methods We did the retrospective analysis of 13 cases and 30 cases of cryptococcal meningitis the clini cal manifestations of patients with tuberculous meningitis, cerebrospinal fluid changes and characteristics of CT or MRI of the head. Results There were significant differences in intraeranial pressure and glucose value of CSF, positive rate of polymerase chain reaction for tuberculosis （TB）（PCR-TB）, positive rate of lipoarabinomannan antibody （LAM-Ab） in CSF, between TBM and CNM. However, there were not significant differences in clinical manifestation, white cell count in CSF, protein value, chloride value, head CT or MRI imaging between TBM and CNM. Conclusion It is not a typical characteristic of cryptococcal meningitis and tuberculous meningitis for clinical features, that causes to easy to misdiagnosis. The analysis of PCR-TB with intracranial pressure and cerebrospinal fluid changes is good for the differential diagnosis of eryptococcal Neoformans meningitis and tuberculous meningitis, but to make a definite diagnosis depends on finding cryp- toeoceal Neoformans in cerebrospinal fluid.