肝炎肝硬化患者隐球酵母菌属感染临床荟萃分析

Clinical analysis of hepatitis and liver cirrhosis complicated with cryptococcal infections:a meta-analysis

目的分析隐球酵母菌属感染在肝炎肝硬化人群中的发病情况,增强医务人员对该病的了解,以减少误诊。方法检索1989年1月-2012年12月中国生物医学文献光盘数据库、万方数据库、中文科技期刊全文数据库中发表的肝炎肝硬化合并隐球酵母菌属感染病例报道文献,由两名研究者独立进行数据提取与统计分析。结果共33篇文献中的111例患者纳入研究,男性多于女性,平均年龄39.3岁;111例患者中表现为隐球酵母菌性脑膜炎的有109例,占99.1%;文献统计结果显示,临床表现93.5%的患者发热、85.1%的患者头痛、51.1%的患者有脑膜刺激征、34.0%的患者有意识异常、87.5%患者存在脑脊液压力升高、78.9%的患者存在血糖降低,其中有1例患者甚至出现顽固性低血糖。结论肝炎肝硬化合并隐球酵母菌属感染以青壮年男性多见,主要表现为隐球酵母菌性脑膜炎,临床表现以发热、头痛、脑膜刺激征、意识异常、视听神经损伤为主。

OBJECTIVE To prompt the clinical recognition of liver cirrhosis complicated with cryptococcal infections and reduce misdiagnosis by analyzing the incidence condition of this disease in China. METHODS Studies on the case reports of liver cirrhosis complicated with cryptococcal infection were collected through researching the papers between Jan. 1989 and Dec. 2012 on CBMdisc, Wanfang Full-text Database, and Chinese VIP Full-text Database. Data extraction and statistical analysis were independently completed by two researchers. RESULTS A total of 111 patients （with more males than females, average age 39.3 years） collected from 33 papers were included in the study. Among the 111 patients with liver cirrhosis complicated with cryptococcal infections, there were 109 patients with meningitis due to Cryptococcus, accounting for 99.1%. The statistical results showed that the manifestation of fever was present in 43 patients （93.5%）, headache in 40 （85.1%） , meningeal irritation sign in 16 （34.0%） and abnormality of consciousness in 16 （34.0%）. Of the 32 patients who underwent lumbar puncture, 28 cases had increased cerebrospinal fluid pressure, accounting for 87.5%; of the 19 patients for whom glucose was detected, 15 patients had decreased blood glucose, accounting for 78. 9%, including a patient complicated with cryptococcal sepsis deteriorated with refractory hypoglycemia. CONCLUSION Liver cirrhosis complicated with cryptococcal infection was commonly seen in young males. Patients with liver cirrhosis complicated with cryptococcal infection have been reported to manifest mainly as cryptococcal meningitis. The main clinical manifestations of cryptococcosis with meningitis were fever, headache, meningeal irritation sign, abnormality of consciousness, auditory and visual nerve injury.