影响隐球菌脑膜炎预后的相关因素探讨

Studies on predictors in patients with cryptococcal meningitis

目的 探讨影响隐球菌脑膜炎疗效的相关因素。方法 对1980～1995年间诊治的11例隐球菌脑膜炎病例进行回顾性分析。结果 在疗效成功的7例中,联合应用二性霉素B和氟胞嘧啶的效果肯定;其中5例在疗程中进行了侧脑室外引流术,另有1例在疗程初期还联合应用了氟康唑,均获明显临床效果。11例中,4例在抗真菌治疗中死亡,影响其疗效及预后的相关因素主要为:病情进展较快(2/11例)、诊治时间偏迟、宿主免疫功能低下、可累及中枢神经系统的基础疾病及持续性脑脊液显著异常。结论 隐球菌脑膜炎早期诊断困难,抗真菌联合疗法和适时的脑脊液引流是有效的治疗措施。

Objective To investigate the factors that might influence the effectiveness of treatment for cryptococcal meningitis. Methods Retrospective analysis was conducted for 11 patients with cryptococcal meningitis admitted to Peking Union Medical College (PUMC) Hospital during 1980-1995. Results Seven of 11 patients with cryptococcal meningitis were successfully cured with combination of amphotericin B and flucytosine for 14 to 31 weeks (five months in average), paraventriculostomy was performed in five of them with hydrocephalus complicated with deteriorated mental status and one of them was administered with additional fluconazole for 15 days during its early stage of therapy. Four of the 11 patients died from cryptococcosis during the course of antifungal therapy. The duration of illness varied from three weeks to four and a half months (two months in average) . And four of them had underlying illness with steroids / cytotoxic therapy and another one had AIDS. Factors associated with unfavorable outcomes included more rapidly progress of the illness (2/11), delay in diagnosis and antifungal therapy, severe impairment of host defense mechanisms against infection, underlying illness involving central nervous system, and significantly abnormal cerebrospinal fluid for a sustained period. Conclusions Cryptococcal meningitis could hardly be diagnosed earlier. Combination of antifungal therapy with paraventriculoatomy at adequate time, if necessary, was effective in treatment for it.