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目的 探讨新型隐球菌性脑膜炎 (CM)的临床特点、诊断及治疗方法。方法 对 19例经病原学检查证实的 CM的临床资料进行回顾性分析。结果 (1) CM临床上主要表现为颅高压和脑膜刺激征 ,脑脊液改变与结核性或病毒性脑膜炎相似 ;但本病脑脊液压力均 >2 0 0 m m H2 O (1.96 k Pa) ,其中 >30 0 m m H2 O(2 .94k Pa) 13例 ;(2 ) CM误诊率极高 ,本组 19例中无 1例首诊时确诊 ;(3)本组患者经联合治疗疗效明显提高 ,尤其在二性霉素 B的加量期 ,联合用氟康唑和 5 -氟胞嘧啶 ,对早期控制病情极有帮助 ;(4 )对恶性颅高压的严重病例及时行脑室穿刺、腰池引流及脑室腹腔分流术 ,可赢得治疗的时机 ,提高疗效。结论 CM是以颅高压和脑膜刺激征为特点的亚急性脑膜炎 ,误诊率极高 ,反复腰穿检查有助于早期诊断 ,合理用药及颅高压的有效控制是治疗成败的关键。
Objective To investigate the clinical features, diagnosis and treatment of Cryptococcus neoformans meningitis (CM). Methods The clinical data of 19 CM patients confirmed by etiological examination were retrospectively analyzed. Results (1) CM mainly showed intracranial hypertension and meningeal irritation, and cerebrospinal fluid was similar to tuberculous or viral meningitis. However, the cerebrospinal fluid pressure of this disease was> 200 mmH 2 O (1.96 kPa), with> 30 0 mmH 2 O (2.94k Pa) in 13 cases; (2) CM misdiagnosis rate is extremely high, none of 19 cases in this group were diagnosed at the first diagnosis; (3) The combination therapy in this group of patients was significantly improved, especially In the additional dose period of amphotericin B, combination of fluconazole and 5 - fluorocytosine is very helpful to the early control of the disease; (4) To make timely and effective interventions for venous catheterization, Ventricular peritoneal shunt, can win the treatment of the opportunity to improve the curative effect. Conclusion CM is a subacute meningitis characterized by intracranial hypertension and meningeal irritation. The misdiagnosis rate is extremely high. Repeated lumbar puncture is helpful for the early diagnosis. The rational use of medicine and the effective control of intracranial hypertension are the keys to success.