非人类免疫缺陷病毒相关隐球菌性脑膜炎69例临床分析

Clinical analysis of 69 cases of non-HIV-related cryptococcal meningitis

回顾性分析2013年1月至2019年5月河北医科大学第二医院收治的69例非人类免疫缺陷病毒(HIV)相关隐球菌性脑膜炎患者的临床资料。患者主要临床表现为头痛、发热、恶心呕吐、视力障碍、听力下降,其中合并基础疾病者36例(52%),首诊误诊者30例(43%),合并高颅压者38例(55%);脑脊液检查:白细胞数升高47例,蛋白升高55例,氯化物降低41例,糖降低34例;影像学表现为脑缺血、脑积水、脑膜或脑实质增强。诱导期联合应用抗真菌药物治疗63例,单用抗真菌药物治疗6例。临床症状好转54例,自动出院9例,死亡6例。非HIV相关隐球菌性脑膜炎患者的临床表现、脑脊液常规、生化检查以及影像学检查无特异性,诊断需早期行腰穿检查寻找病原学证据,减少误诊。诱导期联合应用抗真菌药物安全、有效。

The clinical data of 69 patients with non-HIV-related cryptococcal meningitis admitted in the Second Hospital of Hebei Medical University from January 2013 to May 2019 were analyzed retrospectively.The main presentations of 69 patients are headache,fever,nausea,vomiting,visual impairment,hearing damage.Among them,36 cases(52%)had underlying diseases,30 cases(43%)were misdiagnosed,and 38 cases(55%)were complicated with high intracranial pressure.Cerebrospinal fluid examination showed that leukocytes increased in 47 cases,protein increased in 55 cases,chloride decreased in 41 cases,glucose decreased in 34 cases.The imaging findings were cerebral ischemia,hydrocephalus,meningeal or cerebral parenchyma enhancement.During the induction period,63 cases were treated with combined antifungal drugs and 6 cases were treated with single antifungal drugs.The clinical symptoms were improved in 54 cases,9 cases were discharged automatically and 6 cases died.The clinical manifestations,routine and biochemical examination of cerebrospinal fluid,imaging findings are not specific for patients with non-HIV-related cryptococcal meningitis.So early and multiple lumbar puncture should be performed to find etiological evidence to reduce misdiagnosis.The combination of antifungal drugs during the induction period is safe and effective.