新型隐球菌颅内感染的临床特征及治疗转归

Clinical features and treatment outcomes of intracranial infection with Cryptococcus neoformans

目的分析新型隐球菌脑膜炎(CNM)患者的临床特点,为诊断和治疗提供经验与参考。方法回顾性分析医院2011-2014年收治的75例新型隐球菌性脑膜炎患者的临床资料,对患者临床表现、实验室检查、实际临床治疗方案及其疗效转归等数据进行分析。结果 75例患者临床表现多为发热、头痛和呕吐;脑脊液检查显示颅内压升高,脑脊液蛋白、糖、氯化物呈现"一高二低"现象;76.00%患者合并慢性基础性疾病,以肝病多见;对患者脑脊液标本进行增菌培养,共检出新型隐球菌菌株42株,分离菌株对5-氟胞嘧啶、两性霉素B和伏立康唑的敏感性较高;临床上主要采用5组治疗方案,其中应用两性霉素B治疗治愈率较高。结论 CNM患者以颅内高压为特点且多伴有慢性基础病;隐球菌对多种抗菌药敏感,临床对患者采用不同治疗方案及时有效控制是良好治疗和预后的关键。

OBJECTIVE To investigate the clinical characteristics of patients with Cryptococcus neoformans meningitis so as to provide guidance for diagnosis and treatment.METHODS The clinical data of 75 patients with C.neoformans meningitis who were treated in the hospital from 2011 to 2014 were retrospectively analyzed.The clinical manifestations,results of laboratory examinations,actual clinical treatment programs and treatment outcomes were observed.RESULTS Fever,headache and emesis were the major clinical manifestations of the 75 patients.The result of cerebrospinal fluid examination showed that the intracranial pressure was elevated,the cerebrospinal fluid protein,sugar and chlorides presented with the phenomena of ＂one high two low＂.76% of the patients were complicated with chronic underlying diseases,most of whom had liver diseases.The result of culture of cerebrospinal fluid indicated that totally 42 strains of C.neoformans were isolated,and the isolated strains were highly susceptible to 5-fluorocytosine,amphotericin B and voriconazole.5 groups of treatment programs were mainly taken for clinical treatment,and the cure rate of the patients who were treated with amphotericin B was relatively high.CONCLUSION The patients with C.neoformans meningitis are characterized by intracranial hypertension and chronic underlying diseases.The C.neoformans strains are susceptible to a variety of antibiotics.It is crucial for favorable treatment and prognosis to take different treatment programs and effectively control the C.neoformans meningitis in a timely manner.