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目的 总结隐球菌性脑膜炎的资料 ,提高对隐球菌性脑膜炎的认识。方法 回顾性总结近 2 0年 (1981年 10月至 2 0 0 1年 9月 )隐球菌性脑膜炎的一般资料、诊断及治疗情况。结果 共 2 6例患者 ,其中男 12例 ,女 14例 ,年龄 5～ 6 2岁 ,平均 35 6岁 ,有基础疾病者 16例 ,其中系统性红斑狼疮 (SLE) 9例 ,人类免疫缺陷病毒感染或艾滋病 (HIV/AIDS) 4例 ,其他疾病 3例 ;有明确鸽子接触史者12例 ;误诊结核性脑膜炎者 5例 ,狼疮脑病者 6例 ;墨汁染色找到隐球菌者 2 3例 (2 3/ 2 6 ) ,乳胶凝集试验抗原阳性 2 0例 (2 0 / 2 0 )。颅内压明显增高 >30 0mmH2 O者 15例 ,脑室扩大行侧脑室引流者 9例 ;12例给予两性霉素B(AmpB) +5氟胞嘧啶 ,6例又同时加氟康唑治疗 ,5例AmpB +氟康唑 ,1例单纯应用AmpB治疗。AmpB最大用量 :AmpB 10 0 5g+脂质体两性霉素B 2 0g,平均用量 2 6g ;治愈 17例 ,好转4例 ,死亡或自动出院 5例。同时发现近 5年隐球菌性脑膜炎病例数明显增多。结论 近年来 ,隐球菌性脑膜炎发病率明显增高 ,可能和免疫抑制剂和糖皮质激素的应用及HIV/AIDS增多有关 ,减少病死率的关键在于提高早期诊断率 ,治疗仍首选AmpB加 5氟胞嘧啶 ,侧脑室引流可减少AmpB的用量 ,提高治愈率 ,缩短疗程。
Objective To summarize the data of cryptococcal meningitis and improve the understanding of cryptococcal meningitis. Methods The general information, diagnosis and treatment of cryptococcal meningitis in recent 20 years (from October 1981 to September 2001) were retrospectively reviewed. Results A total of 26 patients, including 12 males and 14 females, aged from 5 to 62 years old with an average of 35 6 years old, 16 cases of underlying diseases, including systemic lupus erythematosus (SLE) 9 cases, human immunodeficiency virus 4 cases of infection or AIDS (HIV / AIDS), 3 cases of other diseases; 12 cases of clear contact history of pigeons; 5 cases of misdiagnosis of tuberculous meningitis and 6 cases of lupus encephalopathy; 23 cases of cryptococcosis found by ink stain 2 3/2 6), latex agglutination test antigen positive 20 cases (20/20). Intracranial pressure was significantly higher> 30 0mmH2O in 15 cases, intraventricular dilatation of lateral ventricle in 9 cases; 12 cases of amphotericin B (AmpB) +5 flucytosine, 6 cases also treated with fluconazole, 5 Cases of AmpB + fluconazole, 1 case of simple application of AmpB treatment. AmpB 10 05g + liposomal amphotericin B 2 0g, the average dosage of 26g; 17 cases were cured, improved in 4 cases, 5 cases were killed or discharged automatically. Also found that nearly 5 years, the number of cases of cryptococcal meningitis increased significantly. Conclusion In recent years, the incidence of cryptococcal meningitis was significantly higher, which may be related to the application of immunosuppressants and glucocorticoids and the increase of HIV / AIDS. The key to reduce the mortality is to improve the early diagnosis rate. AmpB plus 5 fluoride Cytosine, lateral ventricle drainage can reduce the amount of AmpB, improve the cure rate and shorten the course of treatment.