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目的总结分析新型隐球菌性脑膜炎的临床特征及治疗方法。方法对我院1999年1月至2009年10月收治的46例新型隐球菌脑膜炎患者临床及预后资料进行回顾性分析。结果46例患者中合并其他疾病者21例,占45.7%;15例患者在病前有明确的鸽子接触史,占32.6%;有误诊史16例。所有患者均给予系统治疗,有3例患者入院2周后由于经济原因放弃治疗出院,并失去随访,其余43例患者以两性霉素B联合5-氟胞嘧啶(5-FC)联合治疗。结果10例痊愈,14例好转,10例转院失访,11例死亡,病死率24.2%,未愈1例。结论新型隐球菌脑膜炎误诊率高,各种原因所致的免疫缺陷是引发隐脑的主要危险因素;尽早明确诊断、联合两性霉素B与5-FC抗真菌治疗、积极控制颅内压是降低病死率、改善预后的关键。
Objective To summarize and analyze the clinical features and treatment of Cryptococcus neoformans meningitis. Methods The clinical and prognostic data of 46 patients with cryptococcal meningitis admitted from January 1999 to October 2009 in our hospital were analyzed retrospectively. Results Among the 46 cases, 21 cases were complicated with other diseases, accounting for 45.7%. Fifteen patients had a clear history of pigeon exposure before the illness, accounting for 32.6%. There were 16 cases with misdiagnosis history. All patients were given systemic treatment. Three patients were given up for discharge after economic reasons for two weeks and were out of follow-up. The remaining 43 patients were treated with amphotericin B combined with 5-fluorocytosine (5-FC). Results 10 cases recovered, 14 cases improved, 10 cases were transferred to hospital lost, 11 died, case fatality rate was 24.2%, unhealed in 1 case. Conclusion Cryptococcus neoformans meningitis misdiagnosis rate is high, immunodeficiency caused by various causes are the main risk factors leading to cryptoencephalitis; as soon as possible a clear diagnosis, combined with amphotericin B and 5-FC antifungal therapy, positive control of intracranial pressure is Reduce mortality and improve the prognosis of the key.